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<br />MINE ID # OR PROSPECTING ID # rl~ [ !"OZ~
<br />INSPECTION DATE _ S1 X71 Q4-
<br />INSPECTOR'S INITIALS v
<br />OBSERVATIONS
<br />~ tw~~ wa.a Ceu~u ~~Q' ~. r (~ac$ ~ ~ D rv(~e~.u` `l~.~u-a-Q Z~ ~?~~,~c~, a.~
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<br />t"~Zt.~' ~ t~"a~~Ma ~ ctnl`G.eu~ ~Pi~,'t~D~tm ~ ~~x.~cC~?,u~ P~.O~.
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<br />~~~ ~c~~ac~ep~ ~ a~~oxanu~Q~, ~r~.~efft f~rP a~i~+~.ewu~,~. ~pr~~rc~~tG~~~-~
<br />U~. ~~+~ ~~~ G~dl `t~?tunv~n~' l~~t `~Z~ C~~ pit ~~ein GQ(%-~~ cwx.p~~ c~Tl~ Gu~~n-
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<br />~ ~ ~
<br />I ~ E Conta t Addre~
<br />_ ec: ^ CE
<br />NAME ~/~.' ^~+~~^~n7 ^ BL
<br />VT~I C~ ~.1- "l~~ ^ FS
<br />OPERATOR ^ HW
<br />STREET (% f,'~ 1 X'X p~j7 ^ SE
<br />^ WQCD (CH)
<br />CITY/STATE/ZIP _~cU~11~?~ ~~ ~(~ k ~2~ ^ OTHER
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