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Forest Service Roads <br />Inspection Form <br />Date: 1111117 <br />Time: <br />Name of Inspector: G ��✓�� <br />Current Panel and XC Being Mined: F XC <br />Road(s) Being Inspected <br />Yes No <br />❑ ❑ 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:(�;D <br />* If any potential subsidence induced features are observed that could cause harm <br />to the public or operations, notify Mike Peacock or Kathy Welt immediately. <br />W \MCC-EngineenngENV PERIvIITTING\REG AGENCIESTEiRMSUnspecnon-Survey USFS Ponds & Rds\Roads\forest service roads inspection form <br />