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Date: ?Avj3 <br />Time —7 vc <br />Name of Inspector: /Ov �A---' - G "i-t <br />Current Panel and XC Being Mined: .Z <br />Road(s) Being Inspected: 77/ <br />Yes No <br />Is the Forest Service road within the p - c,ected ang:e of cra' r of <br />subsidence? If yes. which road( 5): <br />J <br />r <br />Notes: <br />Signature of Ins': ector: <br />Fa ast Par - vice Roach <br />Inspection Form <br />Are there visible surface cracks on the road? If yes. c' .scribe <br />(location, width, length, etc.): <br />Is there any recent evidence of potential subsidence inc'L.eed slope <br />failure? If yes. describe: <br />Are there any otl_er potentially damaging, subsidence induced <br />features on or rear the read? If yes, describe: <br />Is mitigation needed? If yes, list suggestions: <br />* If any potential subsidr�_.ce induced features are observed tn:u could cause I -arm <br />to the public or operatic, _s, notify Jess' :;a Loveland or !'M?' e ?ea_ccock imm edla e. y. <br />