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E <br />PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name:?. tv5 (;0bko► Date: 4 <br />NPDES ID. No. :CO Date Last Inspected: '7 Hw) ll <br />Facility Configuration: Total Incised Pond <br />Site Name: Impoundment #0015 Location:47N 16W 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) efait No N/A <br />2. Lift thickness (inches) <br />3. Compaction according to approved plan CI No N/A <br />4. Burning (specify extend and location) Yes 1° 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 0 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 2de. N/A <br />e) From downsteam foundation area Yes op N/A <br />f) "Boils" beneath stream or ponded water Yes 42, N/A <br />7. Cracks or scarps on crest Yes CO. N/A <br />8. Cracks or scraps on slope Yes 431, N/A <br />9. Sloughing or bulging on slope Yes N/A <br />10. Major erosion problems Yes qmp N/A <br />11 Surface movements in valley bottom or on hillside Yes ®, N/A <br />12. Erosion of toe Yes C12 N/A <br />13. Water impounded against toe Yes Clat, N/A <br />14. Existing embankment freeboard (feet) 557(,0 -5559. 1 1(, 1 Feet <br />15. Cracks, bulging, or erosion on upsteam face Yes N/A <br />16. Visible sumps or sinkholes in slurry surface Yes N/A <br />17. Clogging <br />a) Spillway channels and pipes Yes No <br />b) Decant system Yes No / ii A <br />� <br />c) Diversion Ditches Yes No <br />18. Cracking or crushing of pipes <br />a) Spillway pipes Yes No <br />b) Decant system Yes No <br />19. Trash racks clear and in place Yes No <br />770,1 /5 P'?- <br />F: \Eng \DATA \WP \pond - banks \DAMFORM.wpd <br />