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Yes No <br />❑ ❑ <br />❑ ❑ <br />Notes: <br />Date: 0 ! <br />Time: / ( ct Y� _ <br />Name of Inspector: <br />Current Panel and XC Being Mined: ? C _ C# 5 / <br />Road(s) Being Inspected: ,1177- i / <br />Forest Service Roads <br />Inspection Form <br />0 Is the Forest Service road within the projected angle of draw of <br />subsidence? / If yes, which road(s): <br />/ 1 <br />❑ ❑ 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 />NA <br />❑ ❑ Is mitigation needed? If yes, list suggestions: <br />P j1 s <br />Signature of Inspector: <br />* If any potential subsidence induced fe es are observed that could cause harm <br />to the public or operations, notify Robin Schiro or Mike Peacock immediately. <br />