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Forest Service Roads <br />Inspection Form <br />Date: /01,211-5 <br />Time: o2 ,_3 p <br />Name of Inspector:-�vffcG/ <br />Current Panel and XC Being Mined: <br />Road(s) Being Inspected: rj- -711 _ <br />Yes No <br />'��1-2el EG, &'/-' X <br />[� ❑ Is the Forest Service road within the projected angle of draw of <br />subsidence? If yes, which road(s): <br />❑ R 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 />❑ r2 Are there any other potentially damaging, subsidence induced <br />features on or near the road? If yes, describe: <br />❑ Is mitigation needed? If ves, list su2iaestions: <br />Notes: <br />Signature of Inspector: CLz"Ac- <br />* <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 />