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Forest Service Roads <br />Inspection Form <br />Date: <br />Time: 00Ar'" <br />Name of Inspector: 0 -1 91 K 'A�Woo <br />Current Panel and XC Being Mined:'3� �- <br />Road(s) Being Inspected: j>r y r-w rk- No r ,e-- 67 <br />Ye No n o 4cC e SS <br />❑ F1 /Subsidence? the Forest Service No <br />within the projected angle of draw of <br />If yes, which road(s): <br />❑ ❑ 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 />Votes: <br />S I ) r JeX mil. <br />Signature of Inspector: <br />* If any potential subsidence induced res are observed that could cause harm <br />to the public or operations, notify Ryan Sweetwood or Mike Peacock immediately. <br />