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Forest Service Roads <br /> Inspection Form <br /> Date: 10/ZO /1 8 <br /> Time: JV :3o c,,A <br /> Naive of Inspector: y►A i Ke,'Pe.aCOGIL <br /> Current Panel and XC Bein Mined: [-' 7 Pa L)QL! 10 Kc <br /> Road(s) Being Inspected: �r�r C�� <br /> Yes No <br /> ❑ [��Is the Forest Service road within the projected angle of draw of <br /> subsidence? If yes, which road(s): <br /> ❑ 5V Are there visible surface cracks on the road? If yes, describe <br /> (location, width, length, etc.): <br /> ❑ 9-- 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 /> ❑ [GIs mitigation needed? If yes, list suggestions: <br /> Notes: <br /> Signature of Inspector: <br /> � 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 /> WAMCC-Engineering\ENV PERMITTING\REG AGENCIESTDRMSUnspection-Survey USFS Ponds&Rds\Roads\forest service roads inspection form <br />