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Date: �r I -S t l <br />Time: fD <br />Name of Inspector: 17) <br />Current Panel and XC Being Mined: �'-= <br />Road(s) Being Inspected: f `; <br />Yes No <br />❑ Is the Forest Service road within the projected angle of draw of <br />subsidence? If yes, which road(s): <br />-� <br />❑ ❑ <br />❑ ❑ <br />❑ ❑ <br />❑ ❑ Is mitigation needed? If yes, list suggestions: <br />N/ A <br />Notes: <br />Are there visible surface cracks on the road? If yes, describe <br />(Iocation, width, length, etc.): <br />Is there any recent evidence of potential subsidence induced slope <br />failure? If yes, describe: <br />Ni A <br />Are there any other potentially damaging, subsidence induced <br />features onor ear the road? If yes, describe: <br />Forest Service Roads <br />Inspection Form <br />Signature of Inspector: '� - _ & C <br />* If any potential subsidence induced - . res are observed that could cause harm <br />to the public or operations, notify Robin Schiro or Mike Peacock immediately. <br />