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PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS I <br />Inspectors Name: 17.,,g,0 0 lr %4. Date: / - t (441 , l/� <br />NPDES ID. No.:CO- 0000213 Date Last Inspected: I3 /ki 202 <br />Facility Configuration:Incised Pond <br />Site Name: Impoundment #012 Location:47N16W Sec 36 <br />Mine Name: New Horizon Mine Location:2 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) /Yep No N/A <br />2. Lift thickness (inches) <br />3. Compaction according to approved plan 0 , No N/A V <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 N N/A <br />b.) At isolated points on embankment slopes: Yes 6 N/A <br />c) At natural hillside: Yes 6 N/A <br />d) Over widespread areas Yes 6 N/A <br />e) From downsteam foundation area Yes N/A <br />f) "Boils" beneath stream or ponded water Yes N/A <br />7. Cracks or scarps on crest Yes N/A <br />8. Cracks or scraps on slope Yes 7 N/A <br />9. Sloughing or bulging on slope Yes DI 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 6) N/A <br />14. Existing embankment freeboard (feet) `lt 3)- — 0, 11.0 Feet <br />15. Cracks, bulging, or erosion on upsteam face Yes No N/A <br />16. Visible sumps or sinkholes in slurry surface Yes No N/A <br />17. Clogging <br />a) Spillway channels and pipes Yes II! N/A <br />b) Decant system Yes L N/A <br />c) Diversion Ditches Yes Q N/A <br />18. Cracking or crushing of pipes <br />a) Spillway pipes Yes <br />b) Decant system Yes <br />19. Trash racks clear and in place <br />F: \ENG\ DATA \WORD \POND - BANKS \DAMFORM.DOCDOC <br />1 / . <br />N/A <br />