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<br />MINE ID # OR PROSPECTING ID #: _ ~/1~ 7 3" D~
<br />INSPECTION DATE ~`5Z INSPECTOR'S INITIALS
<br />OBSERVATIONS
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<br />I 6 1's Contact Address
<br />NAME
<br />OPBRATOR
<br />STREET
<br />CITY/STATE/ZIP
<br />M:MI:N\OSS\ERN\INSPECTI
<br />(10/92)
<br />cc:
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