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PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name: 1 Date: 6,13 <br />NPDES ID. No.:CO- 0000213 Date Last Inspected: o13 <br />Facility Configuration: Parcel Incised Pond <br />Site Name: Impoundment #011 Location:46N16W SEC 1 <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) Ye�f No N/A <br />2. Lift thickness (inches) <br />3. Compaction according to approved plan Yes No N/A <br />4. Burning (specify extend and location) Yes D 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 �o1 N/A <br />d) Over widespread areas Yes No N/A <br />e) From downsteam foundation area Yes No N/A <br />f) "Boils" beneath stream or ponded water Yes �,Zi 0] N/A <br />7. Cracks or scarps on crest Yes Noi 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 movements in valley bottom or on hillside Yes N/A <br />12. Erosion of toe Yes kNo N/A <br />13. Water impounded against toe // Yes �NO�% N/A <br />14. Existing embankment freeboard (feet) "> ��� biJ7•�� 11 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 �'Lo , N/A <br />b) Decant system Yes C`No; N/A <br />c) Diversion Ditches Yes `No N/A <br />18. Cracking or crushing of pipes <br />a) Spi l l faay pipe-, 7., Nn - N/A <br />_ `Y <br />b) Decant system Yes LNo' <br />19. Trash racks clear and in place Yes No 11':Ra�.oyt; <br />(d��}1lU 1�1A <br />c l <br />F: \ENG\ DATA \WORD \POND - BANKS \DAMFORM.DOCDOC <br />•rr• <br />