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(Page 2)Pj <br />MINE ID # OR PROSPECITIrNG ID # N-T1-C~Z3 <br />INSPECTION DATE bl TJlq~" INSPECTOR'S INITIALS " C~ <br />~l1' ~(' `pQ~ ~t~D Z~c~i l~l,~ # GIM ~k0 ~~ YZtP au~P~ .AL f70Sk' -j~tQ rlf 2+t6'{ ~6t`l d~ <br />yGe~~ cups G~nizl~~~e 7~r~re-~ ~~e~ tc ro ~I,~ew~G.e u,~.~,~~ <br />~~ y~p cv~r ~~ ~vtQ~+,~cu.r rtk~ pAu ru(~L~ IMP ~ cu~~@ ua.~ GP ~ ~.~ lt~l~ °"p~r ~~!~r <br />~~i1N~td~ 1fne~c~ ~~l~r~n~~,~u~u61~~~AuO'~~tiua.,L~'~Ppp ~~+m lP/udmt~-Cf' <br />~ ~~ <br />~~,~luel~ ~ ~apo~~ pn' -rn~nun~ ~~~~ ~~~ rM ~-~ a,~ ~K~~~ . I~-~lu.~ <br />~ P.eUt~n? ~ Ge~ @~M~¢~ art ~ui1u Q u,(~u~t ~~ ,Ct~vti,.oG~~/~+~+~ia.~ <br />p(>Lt~i~e oe~p~ ~r ~ .~5 rua~~'1~ ~ ~ Mtiuo ~~'~ ~~Gb11~ ~~kt 1 +~i~ ~ <br />~. ctiL1~ ~a~oa w~.e~. rn (~-rxoi~. <br />~~,~j ~~~~~cfi ` ~ ~ ~ ~c~:uc~ wt ~ea8 ao ~c(4-~- +~a~u2~ ~'' hey <br />ua.P~'(~~ M~n~c9 s-,,.mco~ ~~ ~~~I>p cQ~ip~e~,`h~e-Q~ , .~..~ n.~.u`-~1 <br />av~ ~t~t ro~.~q ~~ a~ ~ ~-1a, ~ ~ ~~r~ otit a ~e~.paad ~ ~e~ <br />-TG~~~, ~~~ a ~,,.a(~ ~a~2c Grc~~c~.rplur~(- pew °~`~~~ C°~~~1(.%Q~~ ~, <br />~,~~, M~G~.tiL`fl~ pad , ~ .~+~ ~, ~ ~ ~ ~ U <br />.ti o~t~~ ~~r-rrn~ s~c~~,~~~~ ~ ~a~~~ ~p~'~.~ - ~>4 , <br />~fi~n, ~ / ` ~ T ~e~+n G~ U~eo ~ M~ `~ ~ ~i,~u~um <br />~~c1,~ r~~aana ~~ u~ttitl~cMQ3~ ~~ ~ it T~n~- <br />IN~tG.u.ti~Cl~ ~@ ~ r ro ~t Q,r dim D r ) ``~ <br />I & E Contact Address <br />NAME <br />OPERATOR <br />STREET <br />CITY/STATE/ZIP <br />cc: ^ CE <br />^ BL <br />^ FS <br />^ HW <br />^ HMWMD (CH) <br />^ SE <br />^ WQCD (CH) <br />^ OTHER <br />