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Date: / d/ f <br />Time: / / c�►ti.._ t <br />Name of Inspector: b <br />Current Panel and XC Being Mined: 7.3 =h: C w - <br />Road(s) Being Inspected: F7-3 7 / / <br />Yes No <br />❑ Is the Forest Service road within the projected angle of draw of <br />subsidence? If yes, which road(s): <br />/ I <br />❑ ❑ Are there visible surface cracks on the road? If yes, describe <br />(location, width, length, etc.): <br />JA <br />❑ ❑ <br />❑ ❑ <br />❑ ❑ <br />Notes: <br />Forest Service Roads <br />Inspection Form <br />Is there any recent evidence of potential subsidence induced slope <br />failure? If yes, describe: <br />NA <br />Are there any other potentially damaging, subsidence induced <br />features on or near the road? If yes. describe: <br />Kt R. <br />Is mitigation needed? If yes, list suggestions: <br />NA <br />Signature of Inspector: �F =�� ( D, c�_- <br />* If any potential subsidence induced J tures are observed that could cause harm <br />to the public or operations, notify Ro in Schiro or Mike Peacock immediately. <br />