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PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name: 1, Date: 0 4 eL L 203 <br />NPDES ID. No. : CO- 0000213 Date Last Inspected: 13 /V"/ 2014 <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.: Rick Wolney, 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 Yes No N/A <br />4. Burning (specify extend and location) Yes No 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 Lj) N/A <br />b.) At isolated points on embankment slopes: Yes 6) N/A <br />c) At natural hillside: Yes N/A <br />d) Over widespread areas Yes 709 N/A <br />e) From downsteam foundation area Yes 0.) N/A <br />f) "Boils" beneath stream or ponded water Yes N/A <br />7. Cracks or scarps on crest Yes o N/A <br />8. Cracks or scraps on slope Yes No N/A <br />9. Sloughing or bulging on slope Yes o N/A <br />10. Major erosion problems Yes 0 N/A <br />11. Surface movements in valley bottom or on hillside Yes 0 N/A <br />12. Erosion of toe Yes 7o N/A <br />13. Water impounded against toe Yes 1 No N/A <br />14. Existing embankment freeboard (feet) 12 -- (,7 (0,31 Feet <br />15. Cracks, bulging, or erosion on upsteam face Yes No N/A <br />16. Visible sumps or sinkholes in slurry surface Yes N/A <br />17. Clogging <br />a) Spillway channels and pipes Yes 6. N/A <br />b) Decant system Yes 4° N/A <br />c) Diversion Ditches Yes N/A <br />18. Cracking or crushing of pipes ll <br />a) Spillway pipes Yes OL) N/A <br />b) Decant system Yes A <br />19. Trash racks clear and in place es ;' 90 P EG /8 <br />V (71-1- 0 '''' 6 'I:45P— <br />F: \ENG\ DATA \WORD \POND- BANFS \DAMFORM.DOCDOC <br />`7�e� ,pat. GA- <br />