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Date: c: ! <br />Time: (C� 4'- <br />Name of Inspector: <br />Current Panel and XC Being Mined: (= <br />Road(s) Being Inspected: f= .';.. 7 1 r <br />Yes No <br />A. ❑ <br />❑ ❑ <br />❑ ❑ <br />❑ ❑ <br />Notes: <br />Forest Service Roads <br />Inspection Form <br />j - ` <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 />NA <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 A <br />the road? If yes, describe: <br />❑ ❑ Is mitigation needed? If yes, list suggestions: <br />N A <br />Signature of Inspector: <br />* If any potential subsidence induced feiures are observed that could cause harm <br />to the public or operations, notify Robin Schiro or Mike Peacock immediately. <br />