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Forest Service Roads <br />• Inspection Form <br />• <br />Date: <br />Time: <br />Name of Inspector: Gr ry k. We--1 F <br />Current Panel and XC Bein Mined: 4 LI •Atvo e. E 2 -PEI <br />Road(s) Being Inspected: , Fi ri <br />) <br />Yes No <br />ID /Iv <br />❑ IT Are there any other potentially damaging, subsidence induced <br />features on or near the road? If yes, describe: <br />• fiv <br />Notes: <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 />Is mitigation needed? If yes, list suggestions: <br />Signature of Inspector: �J <br />* If any potential subsidence induced features are observed that could cause harm <br />to the public or operations, notify Ryan Sweetwood or Mike Peacock immediately. <br />