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<br />MINE ID # OR PROSPECTING ID # M Dom'- ~ y`f
<br />INSPECTION DATE /e ^.7 G ~~~ - r~I INSPECTOR'S INITIALS~~S
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<br />I & E Contact Address
<br />NAME 1L~k~-r l~~iv~o".c~0 ' /
<br />OPERATOR ~j~ ~ /~p ~O" V ~ ~ ~ N~yYV Coal r
<br />STREET 1'c ~ r OJ IS'~ / / ~~Y p,~ C /
<br />CITY/STATE/ZIP ~~il~Ar O O O(O
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<br />^ BL ~
<br />O FS
<br />^ HW
<br />^ HMWMD (CH)
<br />^ SE
<br />^ WQCD (CH)
<br />^ OTHER
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