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Forest Service Roads <br />Inspection Form <br />Date: ///1/17 <br />Time: 0, 1'3 _f— -� <br />Name of Inspector: ? f <br />Current Panel and XC Being Mined: <br />Road(s) Being Inspecte� <br />J� <br />Yes No <br />❑ l2 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:/.c 0� G� c �t �C �a4�r Gc c•�� <br />Signature of Inspector: .�6206441�1� <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 />WAMCC-Engineering\ENV PERMITTING\REG AGENCIESTDRMSUnspection-Survey USFS Ponds & Rds\Roads\forest service roads inspection form <br />