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<br />MINE ID # OR PROSPECTING ID # ~O~ ~-y-~I'
<br />INSPECTION DATE 9 I ~-q ~} INSPECTOR'S INITZALS~~
<br />OBSERVATIONS
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<br />i & E COntaCt Address
<br />NAME ~1T11-U.~ ~ ~~
<br />OPERATOR ~~\I 14-- r.
<br />STREET ~ ~ O ~ bCl ~C ~ l I ---
<br />CC: ^ CE
<br />^ BL
<br />^ FS
<br />^ HW
<br />^ HMWMD (CH)
<br />^ SE
<br />^ WQCD (CH)
<br />^ OTHER
<br />CITY/STATE/ZIP
<br />
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