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PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name: !��< <br />CIRCLE OR WRITE IN APPROPRIATE <br />Date <br />NPDES ID. No.:CO- 0000213 <br />Date Last Inspected: <br />Foundation Preparation (removal of vegetation, stumps., topsoil) YeSj No <br />Facility Configuration: Cross Valley Pond <br />Site Name: Impoundment #007 Location:46N15W SEC 6 <br />Mine Name: New Horizon Mine Location:l mi.NW of Nucla, CO. <br />Mine ID No.: CDMG Permit #0008 -81 <br />Owners Rep.: Rick Wolney, Mine Manager <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 />N/A <br />N/A <br />N/A <br />Feet <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />CIRCLE OR WRITE IN APPROPRIATE <br />RESPONSE <br />1. <br />Foundation Preparation (removal of vegetation, stumps., topsoil) YeSj No <br />2. <br />Lift thickness (inches) <br />_ <br />3. <br />Compaction according to approved plan <br />(Y!5� No <br />4. <br />Burning (specify e °:tend and location) <br />Yes No <br />5. <br />Angle of slope: 3:1 upstream, 3:1 downstream <br />6. <br />Seepage (specify location, color, and approx. volume) <br />a.) From underdrain pipes: <br />Yes ,N <br />b.) At isolated points on embankment slopes: <br />Yes (No <br />c) At natural hillside: <br />Yes Nom <br />d) Over widespread areas <br />Yes <br />e) From downsteam foundation area <br />Yes kN9) <br />f) "Boils" beneath stream or ponded water <br />Yes (N0 <br />7. <br />Cracks or scarps on crest <br />1 <br />Yes i NO <br />�1 <br />8. <br />Cracks or scraps on slope <br />Yes No,) <br />9. <br />Sloughing or bulging on slope <br />Yes <br />10. <br />Major erosion problems <br />Yes �Noi <br />11. <br />Surface movements in valley bottom or on hillside <br />Yes Q`5; <br />12. <br />Erosion of toe <br />Yes <br />13. <br />Water impounded against toe <br />Yes No <br />14. <br />Existing embankment freeboard (feet) <br />15. <br />Cracks, bulging, or erosion on upsteam face <br />Yes No <br />16. <br />visible sumps or sinkholes in slurry surface <br />Yes No <br />17. <br />Clogging <br />a) Spillway channels and pipes <br />Yes No <br />b) Decant system <br />Yes I�N) <br />c) Diversion Ditches _ <br />_ Yes \N�` <br />18. <br />Cracking or crushing of pipes <br />a) Spillway pipes <br />Yes <br />b) Decant system <br />VPC No' <br />19. <br />Trash racks clear and in place <br />r r { <br />0 <br />f r. , <br />F: \ENG\ <br />DATA \WORD \POND - BANKS \DAMFORM.DOCDOC <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 />N/A <br />N/A <br />N/A <br />Feet <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />