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Forest Service Roads <br />Inspection Form <br />Date: w1194 110 <br />Time: 1 : Mew, a1 <br />Name of Inspector: �2-Y(s <br />Current Panel and XC Being Mined: a - f7a <br />Road(s) Being Inspected: V rl f L.00j btA,. dose 6uttl, <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 />❑ 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: 4 <br />* If any potential subsidence ind&ed fea res observed hi4kould cause harm <br />to the public or operations, notify Ryan Sweetwood or Mike Peacock immediately. <br />