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i •, ~ (Page 2) • <br />~ ,MINE ID # OR PROSPECTIIN^G ID #: m -~~-~{z~ <br />INSPECTION DATE: ~ l p. 1 ~ 1 INSPECTOR'S INITIALS:_~_ <br />OBSERVATIONS <br />1~i C ~~ ~ (s~ oN Cpt~,p ~l.c.`}~ R- MAN - I~RI -'~,! Cr '~l5 ~~~{l c7t~1 O'F,3.I~ t' <br />5 l'~~ orb q 1~.1q°~ . 1 rsR.m 11' ~~-s Ft~s~ ~SSu.t~J -I-cs ~~ w~ <br />~ 4 ~I. l S t o tit O F tt l (sr t{ c,J R~ S ft-N,p T(Litt~tg ~iia'.A "1'o L - N. CD N COt)N.~~ <br />~ ~ ~, ~~ . p~,~~ ; .Du..~~n! G, -1-~ ~ ~~ g plc i r oil w,~-s m 2• <br />~ ~"~ Aw~crou; o F ~ - ~ ~ N cou.~i-~ . <br />w N ~ Q~4 m - i o~c~l w ~ ~~~y c.r,•i A-PPX- 3 s f--e.R~ ~o f= <br />w K - c H b u~-f- ~ O ~ ~2~s s ~--t LL `~-~t1 u. t e.c~ R Z.L-t-rvt -~+I owl . <br />~L~ o~ ~t aS ~2~ orZ so "w~ iz.~~~m~ Sy <br />C~ D I ' i ---t ~ I v P--c. fZr~ - .S ~ r-t ~ ~ L. ~ N; c. ~ N c..0~k.n~l1-~/ <br />M - t~.1 e"3 o N ~ ~ ~ F3fr51 S • 1~ ~ f2zZC~tt mkt, ~~} <br />5N Fl~PC c~ ~ -i-v« Q~R.m -1 Ac-2PrCT ~~ ~ ~~~ t~~ 'i'~m - j <br />~o,~..~c.~ ~y rn r1--2 k~.S , -tom c ~ ~-t-f~.~,R~t~ ~c~°~tu.-~ D 1~ ~ ~ <br />'~~-°rl -~ L ~ b ~ 1 Itil tr ~S ~ ~" S M f t'R- k-~1Z S • -1-~ ~ W f r ~ -tti1 t~ <br />~-}-t`l~i ~' ~ ot~l c~ ~ Lc f~ C~c~ i~S c_.o c~ n(~ `~h~ H fit ~ ~h G '~~lzrn i i <br />:~-Qp L ~ c->~-~I o +~ ! }-I o ~ ~: ~J .L 'r ft-P ~ -S ~~ ~ "off r`i ~Z. <br />o (~ ~ ~ ~ (Zo Q ~ 1~{ f`n ~ SS F'~s~t ~sSZ ~o ~ t~ o t u.~ t~n.i + -1~ e, <br />Co ~ til fiy -ice Rim ~ ~, ~ A•n1 ~ m o Q.~ rn ~~ ~ A-l~ U h1-}- i ~ '~-UI <br />~nU.Du c I Pr~~ -'~-I o n1 h ~ ~-t~ ~ ~ ~~ o N po~fi- o>~ e F ~ <br />~~C.R-- ~ tm s ~ i~ ~ H ~ c H s H ~ Fz~ cs ~p ~ ~p N ~-3- G-~ Psi c~-u.tt-}~~ <br />j ~ PSo i ~ . ~ ~m t i ~ t ~nl ~ t~-S ~ I~-o Pc~,t,~{ Po ~~D -n-a~ a ~i o <br />Y1~ PrsD~ Q~ ~ ~>~7n ,'~ c~ ~ ~ ~-~- ~ -~ n~- ~ o P ~ ~ ~Tls Pc~~ c~-1 <br />I & E Contact Address /~ [,Q ----~,~~ ~` <br />NAME: ~ ~~C' /'T(~~/~! cc ^ BL J lt.r ij~ J,U`~~ <br />OPERATOR: i C .~ Q~ ^ HW <br />STREET: ~ ~ (~ ` a Q k [-~ ~~ Q 5 MWMD (CH) <br />CITY/STATE/ZIP: I-'f ~ J ('..~1 ~ /rl( j),~~~> ~~ as I ^ O~ ER (CH) <br />d~--~`~ <br />