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Yes No <br />❑ ❑ <br />❑ ❑ <br />❑ ❑ <br />Notes: <br />Signature of Inspector: <br />Forest Service Roads <br />Inspection Form <br />/ I <br />Date: t / /6 / { 71'_ <br />Time: ( -- <br />Name of Inspector: (-Rti , I t <br />Current Panel and XC Being Mined: ( 3 1 <br />Road(s) Being Inspected: f <br />, ❑ Is the Forest Service road within the projected angle of draw of <br />subsidence ?If_yes, which road(s): <br />F- - 7 /I <br />❑ ❑ Are there visible surface cracks on the road? If yes, describe <br />(location, width, length, etc.): <br />N1 Q <br />Is there any recent evidence of potential subsidence induced slope <br />failure? If yes, describe: <br />NA <br />Are there any other potentially damaging, subsidence induced <br />features on or near the road? If yes, describe: <br />Is mitigation needed? If yes, list suggestions: <br />NA <br />* If any potential subsidence induced fes are observed that could cause harm <br />to the public or operations, notify Robin Schiro or Mike Peacock immediately. <br />