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Forest Service Roads <br />Inspection Form <br />Date: 411 l /3 <br />Time: /;7-:o0P'r2 <br />Name of Inspector: M. Pe A" &4', <br />Current Panel and XC Being Mined: 874. ) rG <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 />711,24 <br />❑ Are there visible surface cracks on the road? If yes, describe <br />(location, width, length, etc.): <br />❑ u 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, des rib <br />Salis�Nc� h/As cAclSEb Re►��,v�kG,c 15sue5 <br />❑ Is mitigation needed? If yes, list suggestions: h <br />Ar i,U AreeV 4v rArse. +!tic alev.4T/ON op f4c. <br />Notes: A�'�'�x �m�rE x y i <br />Signature of Inspector: 62-et� <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 AGENCIES\CDRMS\Inspection-Survey USFS Ponds & Rds\Roads\forest service roads inspection form <br />