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Da,e: 4/7 <br />Tirne: /i. n)(Liv <br />Name of Inspector: <br />Current Panel and XC Being Mined: 6 <br />Road(s) Being Inspected: <br />Yes No <br />Notes: <br />Forest Servf.�e Rods <br />i; r s aeeti oar Form <br />is tl_r Forest Serve e road within tl = p_ angle of dra 7 of <br />subsidence'? If yes, which i <br />��ich roar. s ; <br />Are there visible surface the road? if yes, descrit <br />(:::_ ration. width_ length, etc.): <br />r7 <br />is there any recent evidence ofpotei subsidence induced s opf. <br />fai:ure? If yes, describe: <br />u Are the -e any other potentially j <br />} t ✓ damaging, subside' : ;e induced <br />features on e' ! ear the road? If yes describe: <br />7/ Is mitigation needed? If yes, list suggestions: <br />Signature of ins e t-_, - : __ / <br />* If =ny potential subsid- .' e induced features are observed that could cause harm <br />to the public el cperatic �s, notify Robin Schiro or Mike Peacock immediately. <br />