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Date: 0 -3 Z / 1 ?_- <br />Time: t p <br />Name of Inspector: _, ; ;, ,_, <br />Current Panel and XC Being Mined: ,,= _ x C I <br />Road(s) Being Inspected: , 5- 7 / I <br />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 />' - 711 <br />❑ ❑ Are there visible surface cracks on the road? If yes, describe <br />(location, width, length, etc.): <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 />N A <br />Are there any other potentially damaging, subsidence induced <br />features on or near the road? If yes, describe: <br />N. a <br />❑ ❑ Is mitigation needed? If yes, list suggestions: <br />NI <br />- <br />Signature of Inspector:_ _ <br />* If any potential subsidence induced fres are observed that could cause harm <br />to the public or operations, notify Robin Schiro or Mike Peacock immediately. <br />