(Page 3)
<br />MINE ID # OR PROSPEyCTING ID # ` ~~~
<br />INSPECTION DATE 1 /I~/9 ~ INSPECTOR'S INITIALS,
<br />~?$~SRVATIONS
<br />"l;li, ~fI/~ R,v-~~ IIA,~d,, S,ti,,,c{,L{, ~fIS L~Gvt ~w lwn.GVCGL~ 0~,~'G
<br />JJ++ Si~~ ~ ~ f~~ iwS~Ct~ow ~ o~ pcr~5~,¢v-- C~'+-~.o ~(.e~/
<br />l5 5~~~ 1 V~~i ~iJ~' l t~ 4-ni~Ve.dQ. ~'u~~S SP+Lfu cK..-C~
<br />1~ p i
<br />e~ G~ rcU~S.CGL pp5 w„ub ~('~v . °~,~ 5 tkGP.Yv ~~~Gj tit 1~ t..1~ ~~, c-9:~" i ~,, v ~G
<br />v 5 6GiQ, ~ cwwct~ C1 Jn cQAivl" S+a ~< 1 ~~~ S l b req,~ 6t,Gcw ~ y
<br />QwSl~t- ~C+Sc.vSF16v< U,~i~w~~ pGaVeXe.c~, (11~.~biwG lrP~~c~n.~.+~/E'/~a.~. I,~
<br />I ks iw .(v Bv~Gei o k ~/~iRi ~~l I.~t. w+.~.~o v ~. 6~~i6 ~ac f.4,~ pia kG(/ ~/ f
<br />5000.00, ~; i5 l+A~ re~wvGG~[. wf p5v~ti~ie+~-0y_.~ ~i/f' - /~~S Y~~iL
<br />6s ~ f w h r, b 1.E+.+„ ~ ~' l w N.PM/ ~, ~2 cwv+0./ "''9 ; ~/ GG*~l cv f ~~.
<br />rr0 ~ Y'~(~t wi......~'1 cCii 5 f ~ vii c..+..(/~2. w ii"^~~ ~-~. .~,Q~ /yQ,V ,v„i T ctv~ e.c/ t~
<br />q~~ ~~~ ~ V~//'F i "`~ ~ ~i vim. /%[~'f'i /I ~'~/ ~ 1- ~
<br />(5u,S5 ~, ~ e~S e Gavclru~ w Ot'sf l~(,P~ `(-e~(.,n,; c
<br />-
<br />1i u,~ `~e.V l's ~e.~,, 'Fo ~~
<br />y{.,~csu,~.4J~lav+ ~la,.,, • l'~-~ a
<br />n
<br />Gtr~+.~~ 5(..av~
<br />I va.Vi.e^,/ ~i ~p~ft~.~l
<br />5
<br />l
<br />7
<br />~
<br />yrr.S
<br />.~.,~/
<br />t Lt~.~-
<br />(
<br />,-C.~,lccu
<br />.+.r,~',
<br />cw h
<br />w, 6(n.~.~,
<br />~a
<br />1 /
<br />hVrirlSei C~lu.n~fiS YD
<br />(
<br />A
<br />_
<br />.(.
<br />{ ~t'i ~f 0 h-1 i
<br />l ~
<br />I, l
<br />1
<br />,
<br />~
<br />t
<br />K
<br />/
<br />~/~, i -
<br />`
<br />V N,
<br />~4~t i 5 ~LC' UY II~.L~ I+w ,i~ r i
<br />~vj-v`'ei
<br />1,./til~ ~i
<br />~~
<br />/
<br />~
<br />VSP~ OF- Yu~ Sufi.
<br />lucre ''/~'~i lnb h rr ~S I.Gv~..s v(.a~cQ dv v-1`c,~ ~vi s Ittis(K~-t i rte,. .
<br />I 6 E Contact Addr
<br />~~
<br />OPERATOR
<br />STREET
<br />CITY/STATE/ZIP
<br />cc: ^ CS
<br />^ BL
<br />^ FS
<br />^ ttw
<br />^ HMWNID (CH)
<br />^ SS
<br />^ wQCD (CH)
<br />^ OTHER
<br />
|