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PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name:is Date: 111rn 1:-CS <br />NPDES ID. No.:CO - 0000213 Date Last Inspected: 14 zoort- <br />Facility Configuration: Total Incised Pond <br />Site Name: Impoundment 4009 Location:47N16W SEC 36 <br />Mine Name : New Horizon Mine Location : l mi . NW of Nu c a , CO. <br />Mine ID Nn.: CDMG Permit #0008 -81 <br />Owners Rep. : R. L. Wade, Mine Manager <br />CIRCLE OR WRITE TN APPROPRIATE RESPONSE <br />1. Foundation Preparation (removal of -- egetaclon, stumps., copsoil) No N/A <br />2. Lift thickness (inches) <br />Compaction anrr ng to appro• red olan No iT /A <br />Burning (specify e_cend and location) Yes g51 N/A <br />5. Angle of slope: 3:1 upstream, 3:1 downstream <br />G. seepage (specify location, color, and appr= volume) <br />a.) From underdrain pipes: <br />b ! At isolated points on embankment slopes: <br />c) At natural hillside. <br />d) Over widespread areas <br />e) From downsteam foundation area <br />f) "Boils" beneath stream or ponded water <br />7 Cracks or scarps on crest <br />Cracks or scraps on slope <br />9. Sloughing or bulging on slope <br />10 Major erosion problems <br />11. Surface movements in valley bottom or on hillside <br />1 Erosion of toe <br />13. water impounded agalnsc toe ,y <br />14 E_:isting embankment freeboard (feet) 5 4 <br />#q. { — scoA. ' <br />15. Cracks, bulging, or erosion on uusteam face <br />16. visible sumps or sinkholes in slurry surface <br />17. Clogging <br />a) Spillway channels and pipes <br />Pond L5 dYK <br />h) Decant system <br />c) Diversion Ditches <br />Cracking or crushing of es <br />Yes 0 <br />.es Q <br />Yes <br />Yes CID <br />Yes <br />Yes <br />Yes <br />Yes <br />Yes 0 <br />Yes 0 <br />Yes <br />Yes <br />Yes NO <br />Yes <br />,es <br />Yes <br />Yes <br />_'es <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />Feet <br />N/A <br />N/ <br />a) Srillwa_ pipes (: N/A <br />b) Decant system Yes C;* N/A <br />Trash racks clear and in place T: N/= <br />Div <br />N/A <br />N/A <br />N/A <br />