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• <br />• <br />Date: / // <br />Time: t : S f <br />Name of Inspector: A. <br />Current Panel and XC Being Mined: — 'rG 3 <br />Road(s) Being Inspected: p-' or <br />Yes No <br />Notes: <br />0 <br />Forest Service Roads <br />Inspection Form <br />[] Is the Forest Service road within the projected angle of draw of <br />subsidence? If yes, which road(s): <br />Q y PorL <br />Are there visible surface cracks on the road? If yes, describe <br />(location, width, length, etc.): <br />1111 ❑ ❑ 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 />aClesi — 5/VOk/ (o vN Kc <br />Signature of Inspector: 41111, <br />* If any potential subsidenc induced f; atur . - obse <br />to the public or operations, notify Ryan <br />at could cause harm <br />etwood or Mike Peacock immediately. <br />