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Forest Service Roads <br />Inspection Form <br />Date: lQ1 /v 1..--oly <br />Time: i <br />Name of Inspector: .0�LL 1' zr d <br />Current Panel and XC Being Mined: S .l'C' -5;"y Road(s) Being Inspected: ;' _� i <br />Yes No <br />❑dk Is the Forest Service road within the projected angle of draw of <br />subsidence? If yes, which road(s): <br />❑' , Are there visible surface cracks on the road? If yes, describe <br />(location, width, length, etc.): <br />❑ Is there any recent evidence of potential subsidence induced slope <br />failure? If yes, describe: <br />❑ Are there any other potentially damaging, subsidence induced <br />features on or near the road? If yes, describe: <br />❑ / ❑ Is mitigation needed? If yes, list suggestions: <br />Notes: <br />Signature of Inspector: <br />* If any potential subsidence induced features are observed that could cause harm <br />to the public or operations, notify Jessica Loveland or Mike Peacock immediately. <br />