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<br />7 (Page 2) l4 •
<br />MINE ID # OR PROSPECTING ID #: o/-~ _ 77- ~9 J
<br />INSPECTION DATE: ~-5-~ O INSPECTOR'S INITIALS: `~~
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<br />OPERATOR: TQ_~tr-r[ t1e,a-uy F au r pr+e,.rT Co ~ IyC C FS
<br />C HW
<br />STREET: $64 ~ I (2ST- ST C HMWMD(CH)
<br />C SE
<br />CITY/STATE/ZIP: C/~r.1D1~1 C t'T~ ~~ g lam/ 3- ~~ WQCD (CH)
<br />C OTHER
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