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COUNTY ROAD 33 & POWERLINE SUBSIDENCE SURVEY <br />• <br /> ' Oo qr, <br />7 <br /> DATE: 5' '7 .g TIME: { <br />~ NAME: ~ic~G /I'J, ~~/' <br /> WEATHER CONDITIONS: .>Cenny PANEL: ~ 2,~f <br /> ROAD CONDITIONS YES NO COMMENTS <br /> CRACKING / no _~ ,~,f-i~~~ Cr+ao~,.,~ <br /> BUCKLING ,/ /~~i «~d~ <br /> VISIBLE SETTLING ,/ <br /> SINK HOLES ~ <br /> OTHER <br /> MAINTENANCE Co,vr~huC ~D r usrr~N /.'/Ll~z[=2 ~~~1 <br /> SHOULDER/FILL CONDITION YES NO COMMENTS <br /> CRACKING <br /> BUCKLING <br />• VISIBLE SETTLING a/ <br /> SINK HOLES ,/ <br /> OTHER <br /> MAINTENANCE A/m~_ <br /> POWERLINE CONDITION YES NO COMMENTS <br /> LINE INTACT <br /> X-ARMS O. K. / <br /> CHANGE IN SPAN ,/ <br /> POLE TILTING ,/ <br /> OTHER <br />MAINTENANCE ,d/m.,~~ <br />n <br />e:\document\forms\subside.frm 06107196 <br />