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Forest Service Roads <br />Inspection Form <br />Date: 3130 A g <br />Time: 9 tg16 i ^'1 - <br />Name of Inspector: rl'(c VX'0 6 <br />Current Panel and XC Being Mined: 9 -7 <br />Road(s) Being Inspected: -If, (-o r le- -71 <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 />❑ F� 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: <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 PERNIITTINGULEG AGENCIMCDRMSUnspection-Survey USFS Ponds & Rds\Roads\forest service roads inspection form <br />