|
1.
<br />~' ~ =
<br />• (Page 2) •
<br />MYNE ID # OR PROSPECTING IDQ //# t1-7$-34a,
<br />INSPECTION DATE ~a~ ~-'Y ~O INSPECTOR'S INITIALS
<br />OS ERVAT
<br />CeKP(.e ~ e.p i}. Pq-~2~F-~, r-.ss we~rco~c ~}T TF!-t> SGTe ~fzu b¢"Tear[~nrc- ~~f
<br />A[~eq;,Lr4-re Pru,4ht~LO~r~-L wL4RiR~M'Y ReeZu,[aersenrr f=cl2R-ecc.~arrLo-~ta,t
<br />oG-' 'rwe exisrLNG IJtS-ru,Rr~a-Ncsv.
<br />Gu(jY~lerJit`( Al3mu.T ~ ,q.Cp,~S r-{~aJe l3ee.n_) IaLS'TU[.z-L~QIJ. T;./rS cc,s51575
<br />UL= W/~STe [tbCK Dt,tr[/~S~ ~Mt OrRO~Tj /1 PcaTil-l_ C.aRsoPe~ /~U in,r.`D¢;1Glleun:p
<br />~'~QOO C>FVLLGCV t..3WT~F2 ~ti~i ~.,~7'reeL S~o[~ f~i-t4L{~IAi(o; f~ ~G`U3¢Lt ~a/Aie
<br />trA~[J~ POC..eS) /+~ rJ h- 717PS0[c. 4~CFclo~[-e /1-R.e.4, -Tf/~ e.S rIKHTe1J GiesT
<br />To fZeC ~-~ [., T[4 e 5 [ Te [ 5 ~ ~, 5'-6~, oo- SriJC,e rt4e exl ~-r[aJE, ri~'~,oca .,x
<br />=lf~.l/klsC.L~'L, USd}R,fCiQiUF~j rs ti1oT Stif~(c`L¢tiT' `7'HFS cUGC-c. i3e Herz,-i'e[~
<br />f'}5 /-!- PRo/3l.e.r-t ~+~ P~4GL 3 mr= BLS ReM~-`r.. TFfe Pe.Rr[c r-r~.e wrcC.
<br />Y.ie G~[~a~ 30 ~~YS 'rb <}-!'P~aEL -r'[4e ArJ[~eaN'~ ~ts/.1D es77w~t-rr:,
<br />1 h ~'¢ f e2P-4LT'fe2~ GA-.~i.YOT PRp52L.ST /2r17eQ,~.tH7~ e,ur i~earC~
<br />j~ (Z.Pip LLCK T64Q pLJL5 lOA1 ~3 l~o~A e-3 ~GHA-T'e. ~ /1C~TD i.VC2C'/w-Se
<br />r_ez-t'eKt c~~re-l. f52 Sea~STr 7D T7~e esPe2A-r~lZ CwI,LC(n. w[rrc...
<br />12 e Q u L R,Q. 5 t-;-Y~ We T'Y'I4 L 6F ~TLf2 ~~ b f0.SGi2G/{-SQ [,.~ t TL#Gil3 F.A
<br />A (Lc~. ~ (. e. w 0 t= `rFFe ~ [ C, e S S fn.6w -r-FfL4`i- Tb{ t 5 1oe14;'(L'T /-f<t 5 ansLY
<br />3 ~ eK--~S O~ TeY"(!~@re..a/+t[ Ce,SSC~}-i"[Gn~ LQFT I$Q,I~mR-e TFf~ K/Ll2°L
<br />i+Lr+g -r-b !de Re-saa~LUn-Tee oR 2~CLR-rr-tE,b C b~~. 1't98),
<br />~. jur3SS7~IJT[i41~ Pcrrt-r~cr 1 v~ iz[e I~rs7uRf~eA r~l~eR~ ,t~' [S /tiSFe57er~
<br />;.3~"fr~} ~r4LOGe.TaeJ„ i rfe ePeR~q-TCR rvu5 B eR.~l~re~--i~2
<br />/~,e.~ r.3o~c.LOri,S :-~2e.~J, esPecrM-~.uY Tyfe t-FiFc.oc:e.T[sn1,A~2rrV~
<br />7-~q.g s pFt[ n?ra a r t `~4 fo,
<br />J r r-r ~("e v¢nz s
<br />I fi E Con[ac[ Addres
<br />NAME f ~Q,lL.~1 I-4 r~ L~l i ('~ r+ti1
<br />oasRATOR 12 `~/~-/J nLTb. ~*
<br />STREET ~~~~ ~ LIZ.C /7~~ a
<br />CITY/STATE/ZIP rGo AST <P Lr9 . O t!~8
<br />1~1,T, La L-1 sj [.3
<br />(~A, /AEI( ,2~~-(v
<br />~~b J~~C+ta-J.co. FtSv,,ti
<br />/~cL3 K8i25 [+~
<br />i3 ~ H
<br />cc: ^ CE -IO( ~,A./-(L/SO b¢r_ I2,G0
<br />^ eL ~~yyp~o ~ $/30l
<br />o xw /30/3 SIn~K1,.2
<br />^ tnawrID (cx) ~ 6t CIa
<br />^ WQCD (CH)'~~
<br />^ OTHER ~R,LV¢ $6uTL~-
<br />J~3~0
<br />
|