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Forest Service Roads <br /> Inspection Form <br /> Date:9/26/zo,tq <br /> Time: a'.ot e-n- <br /> Name of Inspector: (1-obUr <br /> Current Panel and XC Being Mined: Lw Es ►►-f z xc E"G- <br /> Road(s) Being Inspected: ©I`l <br /> Yes No <br /> ® 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 /> ❑ © 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 John Poulos or Kathy Welt immediately. <br /> (W:\MCC-Engineering\ENV PERMITTING\REG AGENCIES\CDRMS\Inspection-Survey USFS Ponds&Rds\Roads\forest service roads inspection form) <br />