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PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name: LlArci , � (Q Date: (q 4'1/1(4 203 <br />NPDES ID. No.:CO- 0000213 <br />Facility Configuration: Total Incised Pond <br />F: \ENG \DATA \WORD \POND- BANKS \DAMFORM.DOCDOC <br />Date Last Inspected: 17A/26 <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.: 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 <br />4. Burning (specify extend and location) Yes C / <br />o 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/A <br />b.) At isolated points on embankment slopes: Yes N� N/A <br />c) At natural hillside: Yes N/A <br />d) Over widespread areas Yes q- N/A <br />e) From downsteam foundation area Yes I N/A <br />f) "Boils" beneath stream or ponded water Yes mld N/A <br />7. Cracks or scarps on crest Yes hI N/A <br />8. Cracks or scraps on slope Yes o N/A <br />9. Sloughing or bulging on slope Yes N/A <br />10. Major erosion problems Yes N/A <br />11. Surface movements in valley bottom or on hillside Yes J N/A <br />12. Erosion of toe Yes 6 N/A <br />13. Water impounded against toe Yes 6) N/A <br />1 4 . Existing embankment freeboard (feet) I ', 2 d- 3 5 . ( 1,w Feet <br />15. Cracks, bulging, or erosion on upsteam face Yes N/A <br />16. Visible sumps or sinkholes in slurry surface Yes CA N/A <br />17. Clogging <br />a) Spillway channels and pipes Yes No 6 <br />b) Decant system Yes No MLA <br />c) Diversion Ditches Yes No <br />18. Cracking or crushing of pipes <br />a) Spillway pipes Yes No 6 <br />b) Decant system Yes N, "M lei.- <br />19. Trash racks clear and in place Yes <br />r0"-(A 'L 1.1 } <br />Y.IMO' <br />'z tnnJ�CL <br />