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Forest Service Roads <br />Inspection Form <br />Date: 8��8//5/ <br />Time: 0.'00 <br />Name of Inspector: `D ✓c.-I ( X-C �� t <br />Current Panel and XC Being Mined: <br />Road(s) Being Inspected: f 7l/ <br />Yes No <br />❑ Is the Forest Service road within the projected angle of draw of <br />subsidence? If yes, which road(s): <br />FS 7[ i <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 />❑ El 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: r �� <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 />