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Inspectors Name: C,b Date: 1 C} V movL <br />NPDES ID. No.:00- 0000213 Date Last Inspected: 1 Ncd UU <br />Facility Configuration: Total Incised Pond <br />Site Name: Impoundment #009 Location:47N16W SEC 36 <br />Mine Name: New Horizon Mine Location:1 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) 0 No N/A <br />2. Lift thickness (inches) <br />3. Compaction according to approved plan C 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 CE> N/A <br />b.) At isolated points on embankment slopes: Yes ® N/A <br />c) At natural hillside: Yes N/A <br />d) Over widespread areas Yes CP N/A <br />e) From downsteam foundation area Yes CaP N/A <br />f) "Boils" beneath stream or ponded water Yes C70 N/A <br />7. Cracks or scarps on crest Yes CO N/A <br />8. Cracks or scraps on slope Yes dt7 N/A <br />9. Sloughing or bulging on slope Yes 0) N/A <br />10. Major erosion problems Yes N/A <br />11. Surface movements in valley bottom or on hillside Yes N/A <br />12. Erosion of toe Yes P N/A <br />13. Water impounded against toe Yes N/A <br />14 Existing embankment freeboard (feet) E& 1)6, S Feet <br />15. Cracks, bulging, or erosion on upsteam face Yes ® N/A <br />16. Visible sumps or sinkholes in slurry surface Yes 62) N/A <br />17. Clogging <br />a) Spillway channels and pipes Yes CID N/A <br />b) Decant system Yes ® N/A <br />c) Diversion Ditches Yes N/A <br />18. Cracking or crushing of pipes <br />a) Spillway pipes Yes /0 N/A <br />b) Decant system Yes ® N/A <br />19. Trash racks clear and in place CZD No N/A <br />F: \Eng \DATA \WP \pond- banks \DAMFORM.wpd <br />PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />