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(Page 2) 1 ~ Z • <br />MINE ID # OR PROSPECTING ID #: / J- ~JZ - 003 <br />INSPECTION DATE: ~- 3 - Q D INSPECTOR'S INITIALS: G pO <br />OBSERVATIONS <br />~DD`~2tS i~eJ~eGf~oti, wa.f n-.-a~,F.~,¢_-~~. y~~l~aNtC'~o acaV-/-.trao C~ux~Ys /'eye f <br />fG~I"e~eaf~ lLC~Gy« ~o OYt.L ~rea,.c !/ tcel <br />~oCcH / dce~K au l ~ ~-~-Q liy[- lu~pt~~s e sve~.. r -L /cuG~ t"'~~tDEe <br />a n-~~e ~ ~ ~> ~~O ~ e r~ 7`~i < C ~d'o~r~ re~ /-~f-g-~-7L/~/ ~e a /~~~ J <br />7`G,-.,.1~Gtp.~~ar~2GG,ye~fj ~° ~e srfl , /ri^• S~a.w ~~`r ~c r~~ l~assG~n <br />ttiA/7 7~v~~ ~ lei{ a~GCSl rO {!~~/"~~ ~ 7~~sc'I~esf~ <br />Ai ~F f! «.c~ou.~ = o P~~i tc~.ltY Ir m~ to '~ie w r~-~- ~ ~ *~K <br />fv l e ~ e cc s~,. c ss~~ e / ~Za ~ ~ ~-.'ou:~~ ~ ~~~. e'~~. `~ e <br />TLce 9i~ wL.rj / Z ~C. ~r /vie ,tGG?Ij ~~~` Lr~~.ct->r2 <br />~/ ~,~ 2oayG~~ ~ ~ <br />ObS~~-v-e X05 f o~ l ~. ~c~~m,~o Gr~i~~ `i .¢~' /~.G f 6 ~ e~z <br />~:l~e-=.~ ~~ ~~ ~ 1~~ ~ravG~ Cra •~-~r~~7~~ op~ c <br />/P `'t s~~~e ~P D~D~,'s,~•.'/s~l~'7d~~'Jf~f ~~s~e~~G [~ ~-/~T~~/'~' <br />C7~Gi"'a'y."S~ t~ ~~ ~°/CtC /LLGIi! Sdti'~!/k~ ~QFC !~'~~- /~ll,LcC(~~1 <br />f ! o/J~c~t~(~~~r ~ ~-~~ ,~^o, ~.-7/~C~ .e„~., t ~-fie//' az2-~~~/J/-~ <br />d X11 /~sv'y7//~~-' _, "~G ~ ,~t/G/~zJ-`~~y~/" %!(r1/ OL GI.L//7~ `~~/ dvL 6/"Z ~o~ 9N/-ye~_ <br />~ elb~ ~L~/ u-f//~ S /~~ L° y- ~ ~ !7 L~`/eJY ~Z~/ P C-o~C~-+/~ !~-.GL~ L~t-S YJ <br />e Dr vtf<v+-~ aGG/Gfs GG~'D( i~d'/ (JQ G6~.~r'CG(,v,.~_ <br />I & E Contact Address <br />NAME: <br />OPERATOR: <br />CITY/STATE2IP: <br />cc: ^ CE <br />^ BL <br />^ ES <br />^ HW <br />^ HMWMD (CH) <br />^ SE <br />^ WQCD (CH) <br />^ OTHER <br />