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Yes No <br />u u <br />Forest Service Reis <br />- eetl sn Pori <br />Dae: /,.,� <br />Time: 9 -'U6 <br />Name of Inspector: ,Lc ✓� 1 tC ( <br />Current Panel and XC Being Mined:. a L it e ,476,-( <br />Road(s) Being Inspected: CL { _k <br />Is die- Forest ei`V e toad Within ' t r-. ' . ,'fCted an of dra`' of <br />subsidence? If yes, which road's): <br />Are there Visible surface cra.'_-_s o -i the road? If yes, descrit, <br />`:- .ation, width. length, etc.): <br />Is there any recent evidence of t otei ial subsidence induced s.Jl <br />failure? [f yes, describe: <br />Are. the - e any other potentially darn, gin . subsiderce induced <br />features on €_-.. rear the road? If yes, describe: <br />Is mitigation needed? If yes, list suggestions: <br />Notes: <br />C ` I-aL j' J/ C2 t 7 cc L C C <br />Sign?ture ofI specie,_. <br />If :.ny potential subsidence induced features are observed that could cause harm <br />to the public or cperaticns _otify Robin Schiro cr Mike Peacock iirtmediately <br />