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Yes No <br />❑ ❑ <br />❑ ❑ <br />Notes: <br />Forest Service Roads <br />Inspection Form <br />Date: Q ( ke___9 <br />Time: �-> <br />Name of Inspector: �'S'o �� `j �; �-.( <br />Current Panel and XC Being Mined: <br />Road(s) Being Inspected: °; <br />❑ Is the Forest Service road within the projected angle of draw of <br />subsidence? If yes, which road(s): <br />7 I 1 <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 />A <br />Are there any other potentially damaging. subsidence induced <br />features on or near the road? If yes, describe: <br />NA <br />❑ ❑ Is mitigation needed? If yes, list suggestions: <br />N A <br />Signature of Inspector: _ Y <br />* If any potential subsidence induced tures are observed that could cause harm <br />to the public or operations, notify Robin Schiro or Mike Peacock immediately. <br />