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Forest Service Roads <br />Inspection Form <br />Date: it/ tS ( t $ <br />Time: I - 30 0� <br />Name of Inspector: VA- 1�e �6.cvc <br />Current Panel and XC Being Mined: <br />Road(s) Being Inspected: `Dry <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 />❑ 0' Is there any recent evidence of potential subsidence induced slope <br />failure? If yes, describe: <br />❑ 19" Are there any other potentially damaging, subsidence induced <br />features on or near the road? If yes, describe: <br />❑ a Is mitigation needed? If yes, list suggestions: <br />Notes: <br />Signature of Inspector:'4 � �� "z"" —�; <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-Engtneenng\ENV PERMITTING\REG AGENCIESTEiRMSUnspection-Survey USFS Ponds & Rds\Roads\forest service roads inspection form <br />