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• Forest Service Roads <br />Inspection Form <br />Date: Q/67 f I( <br />Time: -}.: oQ 4ni <br />Name of Inspector: A ctv-ed-Pts <br />Current Panel and XC Being Mined: 0 ( 0 <br />Road(s) Being Inspected: n r c.„ L- <br />Yes No <br />❑ Is the Forest Service road within the projected angle of draw of <br />subsidence? If es, which road(s): <br />i* P <br />El ❑ Are there visible surface cracks on the road? If yes, describe <br />(location, width, length, etc.): <br />❑ ❑ <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 />ro,c-cle4s. ile - 5No1.i 2'LrEaet3:P) <br />Signature of Inspector: <br />* If any potential subsidence i - • ' features are observed that could cause harm <br />to the public or operations, notify Ryan Sweetwood or Mike Peacock immediately. <br />