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Forest Service Roads <br />Inspection Form <br />Date: 10112-( i s <br />Time: 1 D : 3o <br />Name of Inspector: y,-% i Kv <br />Current Panel and XC Being Mined: [ 7 1�c',uP.C. to i(C <br />Road(s) Being Inspected: 11A, 17or K,) <br />Yes No <br />❑ 0/ Is the Forest Service road within the projected angle of draw of <br />subsidence? If yes, which road(s): <br />❑ 0"" Are there visible surface cracks on the road? If yes, describe <br />(location, width, length, etc.): <br />❑ 2- 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 />❑ <br />M ---Is mitigation needed? If yes, list suggestions: <br />Notes: <br />Signature of Inspector: <br />g p <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-EngmeenngENV PERN=1NOREG AGENCIESTDRMSVrispection-Survey USFS Ponds & Rds\Roads\forest service roads inspection form <br />