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Inspectors Name :'..55 Gu\o Date: 14. '5 - -Lc <br />NPDES ID. No.:00- 0000213 Date Last Inspected: - Trkoo 1k. <br />Facility Configuration: Parcel Incised Pond <br />Site Name: Impoundment #0013 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) Ye No N/A <br />2. Lift thickness (inches) <br />3. Compaction according to approved plan CED. 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 d 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 CD N/A <br />e) From downsteam foundation area Yes CB, N/A <br />f) "Boils" beneath stream or ponded water Yes Cii N/A <br />7 Cracks or scarps on crest Yes N/A <br />8. Cracks or straps on slope Yes ® N/A <br />9. Sloughing or bulging on slope Yes c., 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 N/A <br />13. Water impounded against toe Yes ® N/A <br />14. Existing embankment freeboard (feet) 5,54(:). ( — SSZ..3 7. 8 Feet <br />15. Cracks, bulging, or erosion on upsteam face Yes ® N/A <br />16. Visible sumps or sinkholes in slurry surface Yes Ca N/A <br />17. Clogging <br />a) Spillway channels and pipes Yes SD 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 ® N/A <br />b) Decant system Yes ® N/A <br />19. Trash racks clear and in place No N/A <br />Vora %5 <br />F: \Eng \DATA \WP \pond - banks \DAMFORM.wpd <br />PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />4 F..a_\D 17i <br />