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Inspectors Name: <br />PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Date: ( /111/1, 2x/ <br />NPDES ID. No.:CO- 0000213 Date Last Inspected: 13 * 2u1,2- <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.: Rick Wolney, Mine Manager <br />CIRCLE OR WRITE IN APPROPRIATE RESPONSE <br />No N/A <br />1. Foundation Preparation (removal of vegetation, stumps., topsoil) <br />2. Lift thickness (inches) <br />3. Compaction according to approved plan Ye 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 9 N/A <br />b.) At isolated points on embankment slopes: Yes 0 N/A <br />c) At natural hillside: Yes N/A <br />d) Over widespread areas Yes N N/A <br />e) From downsteam foundation area Yes N/A <br />f) "Boils" beneath stream or ponded water Yes N� N/A <br />7. Cracks or scarps on crest Yes N/A <br />8. Cracks or scraps on slope Yes 1 N/A <br />9. Sloughing or bulging on slope Yes mTd N/A <br />10. Major erosion problems Yes 0 N/A <br />11. Surface movements in valley bottom or on hillside Yes N/A <br />12. Erosion of toe Yes 64 N/A <br />13. Water impounded against toe Yes No N/A <br />14. Existing embankment freeboard (feet) 1a7)- 0,7? cf , 6 ( 5 Feet <br />15. Cracks, bulging, or erosion on upsteam face Yes `V N/A <br />16. Visible sumps or sinkholes in slurry surface Yes ® N/A <br />17. Clogging <br />a) Spillway channels and pipes Yes 0 N/A <br />b) Decant system Yes Cam' N/A <br />c) Diversion Ditches Yes 69 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 />N/A <br />