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(Page 2) • <br />~ MINE ID # OR PROSPECTING ID #: - Z - g <br />INSPECTION DATE:_ ~ ~G~ ~ DO / INSPECTOR'S INITIALS: ~~~ <br />'~' OBSERI / / <br />~~r'IYOs///~T/~O I~t,.rlrC CC///Q./~'/" 4~G~- ~1i~J Qir~u/~f~iu.Ce/ ~/'zC <br />S~.u,~" ,bye ~iLv, eal ~f-~ ~sur~~ °~/. e .2 ex/ r~r~js~~N`~ 7~0 !~ e <br />Su-,^e /H-21 /~~ r f" n-O ~ Pte'-G/~i~Gfic r live ~ /C~ ~ 3 a G /'~ ~i~.e r f <br />I ~'f~`f~~ ~-"r/(,~ ~I"; -~J~,~.~~ r„y~(/~ rs,~~y~a--r-•Ge o ~ S~vl~sGr J <br />~+^~ `~t e G°~-~ wil/ 6-~ ~/b! ~ 7LO ~Jf~J~ SGT Ye ~aA~~~~'" <br />fOGn -¢!~ ob ~~cr~- ~'`~/~~(-mss e ~c ~ ~~//~r ~n~-~-~ e <br />w a7~; ~~ ~oD ~ -O~~ ~^- rl~ ~~' ~-e'-r'"Y~ ~iy~l~ ~/" >ee ~f , <br />~ ~ ~3~ `7F~3 ~q~ <br />I & E Contact Address <br />NAME: J,,~~~~h~ <br />4 <br />STREET: /7Q, ~~~ ~ 6O <br />CITY/STATEIZIP: /j~~;,,,,,~~y ~ ~.~r~~~ <br />cc ^ CE <br />^ BL <br />^ FS <br />^ HW <br />^ HMWMD (CH) <br />^ SE <br />^ WQCD (CH) <br />¢YOTHER <br />