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<br />(PAGE Z>
<br />MINE ID # OR PROSPECTING ID #: M - Q O - 0 I 6
<br />INSPECTION DATE (~7 / 027 ~ QZ :P+S?E,:TOR S INITIALS J GS
<br />OBSERVATIONS
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<br />I & E Contact Address
<br />NAME ~N" ~0 ~~
<br />OPERATOR ~~ pf.¢4IIJ5 `J1D~~ ~'
<br />STREET P•0~ 13fjXJ00
<br />CITY/STATE/ZIP ~~ ~~"~/ C~ 8p1~-
<br />e~-~N ear ~~~, oF~~t
<br />y~.t7 ~ 130x ~~Dp
<br />CI~Npti C~rty,CO 81215
<br />5149E
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