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U <br />LI <br />Notes: <br />Signature of Inspector: <br />Forest Service Roads <br />Inspection Form <br />Date: 76/f <br />Time: 5 ..> c-2--"C <br />Name of Inspector: <br />Current Panel and XC Being Mined: <br />Road(s) Being Inspected: <br />Yes No <br />7 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 />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 the road? If yes, describe: <br />Is mitigation needed? If yes, list suggestions: <br />2 ( 2 (7 7 �C C (G� C _ / 77i' -' <br />* If any potential subsidence induced features are observed that could cause harm <br />to the public or operations, notify Jessica Loveland or Mike Peacock immediately. <br />