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IPage 2) <br />MINE Y~D'# OR PROSP~E/CTING ID #~~~-~S~ ,p <br />INSPECT/I1ON DATE 7 ~a~- 9~ ~f INSPECTOR'S INITIALS~v <br />/io2 LoNV~sla..~ ~v1SPP..t-~Ib1'l . OBSERVATIONS <br />/?iS ~GI A Pty-o~ow-aA~vn~ ilr~~?~~ C~'~~s~c7d-~C~ w~i <br />~¢~~f /~e~~ lt~c,n~ 2dc~ ~ ~n~ L ~~~°H~ ~'~°C/ita /Or; 7l'lcr~ <br />~~ q ~,~ v`/ 3 -.~ ~iG 2d /1~ J'~'Z /2 0,.~ '~ti ydr~2 4rl` ~ ,o/~ <br />"1yY__ o~-/~,~lvh 4k.~ /J.rJCf!-t. / ,f 1`u~l~~o,~~4 3~c~"J`~?~.r~ ~T ~ ~,7 <br />i.,~i T"C <br />%/'~ X0,`7 i ~.S ~'- ~CO ' `oc~l~ g~ aC fY ~y~rc J.r, i~ 7~ ~ `/ <br />~~-I~ ~~ ~s-~• ,~ ~~`~so, ~/ ~~~/~,-/~ w, ~~ ' g d o u~ , 3~r.~ cam. <br />i1'~• a~ n~~ /¢n 4-Q%S ©~t 17xe- sou7t~erw q,~.~ od~ ~- ~xiftilY a~"e2. <br />/!'~ ~! l LJ 4.T /~0/ QC.//~U~ O'i E~/'i' ~ /it tr~Lc~1~/~ ~ /'L ~/~ <br />%~-- o~ sty-a// w. '~~/.7B~/.1 ~ / Nu~4/~'~ Wi f~~%/ <br />,(7wc.GeX OC¢~0 Pwc~~S "l ^7a !~'t /4t ~ ~G vl 7~ J7~~~- <br />/ /j ~ / / c/ ~ ( ~` ~/ iii te/ . <br />oCUsWnJ~7/~aT~~ Caf,f0~lm~~ 'c-JI'l~~ /T ,/ (// ~ / <br />.r-- ~JV A~P~.I d ~ ~0~~ 37~ a l~ ~ :I S l~G. /!u- ?; fJ'7~ <br />//ferP 9r~ ,j~~skG~~yI ~ ~ / o Q .~"//~ <br />! r ~f. R ~ !K W~11 ~K ~~M` l E~ONKf~~ 1. kC~ ~/ "t- <br />is ~ i7 s x y~ ~ ~11 AA ~[ <br />ot~ ;J e~,f`F a~ ~ ~9r-.~,~I`t CTr~I) /~J jJP~vfi~cl/~~j O•bOOs ~'CrGJ. <br />o~ atQ~J are ~ ~,.t~ okTS~(/~ ~ ~h~ alr`~. pa+.c LJ°'/L <br />Pro~a~~ a~r3'F ~ / .~` fec~q ~ ~fL <br />d~ ~ ~~or o~Ker r~(4f'~ ~ -~Prc._ ~i,~s ~o,~ i~3 r2GQilrlee~. /hl~7_ O <br />/y/ 1 WI1L1 Q1L ~o Q1~9 •L(L/~ %/l I~l~''I,~//iN~~ IXJ /H'LI~Q'r!`+/l !^.r r~(~s /~+~I <br />(/~ (-dUO( /1't 9~~1~ . <br />I fi E Contact>AddreLSS (~ cc: ^ Cfi <br />NAME 1CDiL ~cGC 0/C ef! Vt. ^ BL <br />D FS <br />. c i a / j- ~YJ /J ^ HW <br />OPERATOR ~r r ~CC1 T ~L7r~R0 f~ ^ HMW[+ID (CH) <br />~~~ ~ ^ SE <br />STREET r`.Y~/ ~n~~I~ UJGN7GJ /~!'• I~+ ^ WQCD (CH) <br />CITY/STATE/ZIP ~ IOC Go ~~ 5' yo ^ ~;E/R/ A / <br />edr~ ~O N,~! ~ /K <br />