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Date: () / /, ?_ <br />Time: / p <br />Name of Inspector: <br />Current Panel and XC Being Mined: l= <br />Road(s) Being Inspected: ,L'3 -;,' / 1 <br />Yes No <br />0 <br />❑ ❑ <br />❑ ❑ <br />Notes: <br />Forest Service Roads <br />Inspection Form <br />/ <br />Is the Forest Service road within the projected angle of draw of <br />subsidence? If yes, which road(s): <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, d describe: <br />es <br />f LA_ <br />C ❑ 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 />INL <br />Signature of Inspector: , � c <br />* If any potential subsidence induced fi are observed that could cause harm <br />to the public or operations, notify Robin Schiro or Mike Peacock immediately. <br />