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Inspectors Name: '?,_g5 „,bk ,,, <br />Po,,ol 3Dh5c6ri Q� <br />F: \Eng \DATA \WP \pond- banks \DAMFORM.wpd <br />PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Date: /¢ 4 zo /z <br />NPDES ID. No.:CO - 0000213 Date Last Inspected: 7,41 <br />Facility Configuration:Incised Pond <br />Site Name: Impoundment #012 Location:47N16W Sec 36 <br />Mine Name: New Horizon Mine Location:2 mi.NW of Nucla, CO. <br />Mine ID No.: CDMG Permit #0008 -81 <br />Owners Rep.: R. L. Wade, Mine Manager <br />CIRCLE OR WRITE IN APPROPRIATE RESPONSE <br />1. Foundation Preparation (removal of vegetation, stumps., topsoil) 6) No N/A <br />2 Lift thickness (inches) <br />3. Compaction according to approved plan ® No N/A <br />4. Burning (specify extend and location) Yes N/A <br />5. Angle of slope: 3:1 upstream, 3:1 downstream <br />6. Seepage (specify location, color, and approx. volume) <br />a ) From underdrain pipes: Yes C.% N/A <br />b.) At isolated points on embankment slopes: Yes ® N/A <br />c) At natural hillside: Yes Q50 N/A <br />d) Over widespread areas Yes CEP N/A <br />e) From downsteam foundation area Yes ® N/A <br />f) "Boils” beneath stream or ponded water Yes ® N/A <br />7 Cracks or scarps on crest Yes <9 N/A <br />8. Cracks or scraps on slope Yes CEP N/A <br />9. Sloughing or bulging on slope Yes N/A <br />10. Major erosion problems Yes N/A <br />11. Surface movements in valley bottom or on hillside Yes 1� N/A <br />12. Erosion of toe Yes (a N/A <br />13. Water impounded against toe Yes p N® N/A <br />14. Existing embankment freeboard (feet) 5407 3—.559p, 5 g O Feet <br />15. Cracks, bulging, or erosion on upsteam face Yes ® N/A <br />16 Visible sumps or sinkholes in slurry surface Yes Cg N/A <br />17. Clogging <br />a) Spillway channels and pipes Yes N/A <br />b) Decant system Yes N/A <br />c) Diversion Ditches Yes (1› N/A <br />18 Cracking or crushing of pipes <br />a) Spillway pipes Yes ® N/A <br />b) Decant system Yes ill N/A <br />19 Trash racks clear and in place 0. No N/A <br />/er1 pot)-- <br />