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• Forest Service Roads <br />Inspection Form <br />• <br />• <br />Date: `f (. It <br />Time: ' 00 <br />Name of Inspector: lc • 5 / <br />Current Panel and XC Being Mined: � kc <br />Road(s) Being Inspected: I) r <br />Yes No <br />❑ <br />Notes: <br />Is the Forest Service road within the projected angle of draw of <br />subsidence? If yes, which road(s): <br />Dry F �� <br />❑ Are there visible surface cracks on the road? If yes, describe <br />(location, width, length, etc.): <br />f <br />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 />b(it C ( �' <br />,PQ `1d4 <br />Signature of Inspector: <br />* If any potential subsidence induced fatur- are observed that could cause harm <br />to the public or operations, notify Ryan Sweetwood or Mike Peacock immediately. <br />