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Yes No <br />Notes: <br />Sign ?tyre of inspector: <br />* If ,:Iny potential subsidence <br />to the public or operations, <br />Forces `erv_ce ®ads <br />1nsk3ect_on Form <br />Date: / /V / <br />Time: `G. <br />Name of Inspector: <br />Current Panel and XC Being Mined: 3 - -c > <br />Road(s) Being Inspected: , <br />Is :i Forest Serve road within the r - c; cted angle of dra ° of <br />subsidence? If yes, which roads): <br />Are tr re visible surface cracks oT1 the road'? If ves, descriL <br />•.ation., width, length, etc.): <br />Is there any recent evidence of pater vial subsidence induced s :o <br />Lai :ure? If yes, describe: <br />Are the. - e any other potentially damaging, subsidence induced <br />features on e near the road? If yes, describe: <br />Q' is mitigation needed? If yes, list suggestions: <br />" ;,"( <br />ducal features ?re observed that could cause harm <br />tify Robin Schiro cr Mike Peacock immediately. <br />