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Forest Service Roads <br />Inspection Form <br />Date: //Z9118 <br />Time: S NS A*A <br />Name of Inspector: K t K C ' f EAC OC .— <br />Current Panel and XC Being Mined: IE 7 #?Awet )(CSS <br />Road(s) Being Inspected: `Dry F orL 0 C 1) <br />Yes No <br />�] Is the Forest Service road within the projected angle of draw of <br />subsidence? If yes, which road(s): <br />❑ 5r Are there visible surface cracks on the road? If yes, describe <br />(location, width, length, etc.): <br />❑ 2000 Is there any recent evidence of potential subsidence induced slope <br />failure? If yes, describe: <br />❑ Zo'- Are there any other potentially damaging, subsidence induced <br />features on or near the road? If yes, describe: <br />❑ Ly' Is mitigation needed? If yes, list suggestions: <br />Notes: /'�O¢QS �/Y� 6� �rtN. Z`� �TNoE•� �iC�C(.1/�C��iy?'�iv�S <br />CceSs'� <br />L <br />Signature of Inspector: <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:V\4CC-Engineering\ENV PERMITTING\REG AGENCIESTDRMSUnspection-Survey USFS Ponds & Rds\Roeds\forest service roads inspection form <br />