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PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name: Date: Z 6, J-u ,t <br />NPDES ID. NO.:CO- 0000213 Date Last Inspected: Iq Z}ur'c� zUl3 <br />Facility Configuration: Total Incised Pond <br />Site Name: Impoundment #009 Location:47N16W SEC 36 <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 />CIRCLE OR WRITE IN APPROPRIATE RESPONSE <br />1. Foundation Preparation (removal of vegetation, stumps., topsoil) (es No N/A <br />2. Lift thickness (inches) <br />3. Compaction according to approved plan CYe &- No N/A <br />4. Burning (specify extend and location) Yes (Nc, 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 No} N/A <br />b.) At isolated points on embankment slopes: Yes No N/A <br />c) At natural hillside: Yes N/A <br />d) Over widespread areas Yes (Uo-' N/A <br />e) From downsteam foundation area _ _ Yes No, N/A <br />f) "Boils" beneath stream or ponded water Yes To,' N/A <br />7. Cracks or scarps on crest Yes Qo, N/A <br />8. Cracks or scraps on slope Yes No N/A <br />9. Sloughing or bulging on slope Yes No` N/A <br />10. Major erosion problems Yes No -` N/A <br />11. Surface mnvements in valley bottom or on hillside Yes ]o' N/A <br />12. Erosion of toe Yes Qoi' N/A <br />13. Water impounded against toe // Yes No N/A <br />14. Existing embankment freeboard (feet) �} b5�. �. Z Iq, 3 Feet <br />15. Cracks, bulging, or erosion on upsteam face Yes L o� N/A <br />16. Visible sumps or sinkholes in slurry surface Yes o N/A <br />17. Clogging <br />a) Spillway channels and pipes Yes �Ny� N/A <br />b) Decant system Yes N/A <br />c) Diversion Ditches Yes N/A <br />18. Cracking or crushing of pipes <br />a) Spi -llway pipes Yes lNo' N/A <br />b) Decant system Yes (No) <br />> <FU;` <br />19. Trash racks clear and in place Yes � No SIN <br />�.1 <br />F: \ENG\ DATA \WORD \POND- BANKS \DAMFORM.DOCDOC <br />