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(Page 2) <br />MINE ~ID ~ OR PROS PEC'TtI NG I/D •f'l `r~~ ~0~~ <br />INS PBCTION DATE ~7 rlfO'~Cj <br />OBSERVATIONS <br />• <br />INSPECTOR'S INITIALS~Z~ <br />ZKf~v7LdL- D! //~[J /~P/"~+f~ 2~Q. W6f JN-DLG« l~v' Cp7..-/CCI~G/CO'i^' w!!"li <br />p[ (1~ ~"0~9~- [6''".' /GcILt?G~[(i'L" 1OT [G1GCrxY'~ffi~l/L.. 2 {fCGG/ /OZ" ~j~ ,Q <br />f~O. /~- p2 -O~( ~,e ~Z9't-°fl CrC, ~ I f5 JKCIG~~C~ /ciL mi.- Qy~OI/Ccrl foz... <br />~~ ~u-rs=h~i-- ,~y-- c ox ~rYS ~o~-- 7`0 ~ / Q y-e - u-~~f <br /> <br /> <br /> <br />/~'~B GavL~aGcy~Y'~o/~ ~ ~/2~ e ~~G B 61~ ~~/7 / 2 G~ 4~ K~ <br />~O~Jft`M <i-'V~T/~n-e ~.2j`lq-+-[ f .{-/`~~n .y/,~~/~ ~Ct reed /~ LLyQy~~~ ~t~ <br />`,r.LZ,~ ZT-9"~ ~2 ems-- fD~ljw~-rr~`~l' /u~.I ft/[atG~/ Yl P /"~°"e <br />f Ul/'"' <br />I 6 E Contact Addree <br />NAME !)O! K d <br />OPERATOR h10YGG+~G P 32w~.C Y' C7i'T.G//G'1 <br />STREET __'7~q _~~ O n/! <br />CITY/STATE/ZIP ~'~HI~SC' CO. ~(Z~~ <br />cc: ^ CE <br />^ BL <br />^ FS <br />^ HW <br />^ HMWFID (CH) <br />^ SE <br />'~- OTHER ~ /t-• s (cYe.~•-r - D~!~v <br />8ias~l~at/-3r ~~ ~icG~~o ~~!(h,~ <br />