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Date: i .3 <br />Time: - if �r <br />Name of Inspector: <br />Current Panel and XC Being Mined: <br />Road(s) Being Inspected: F-3, -7„1 <br />Yes No <br />Li <br />u <br />Signature of Inspector: <br />Forest Service Roads <br />Inspection Form <br />/ <br />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 />Notes: <br />/L <br />— / ,a , ,24/6_;‘L. f�G f l ✓ �/� <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 />