~~~~~ ~
<br />(PAGE 2)
<br />MINE ID # OR PROSPECTING ID #: ~ _ ~~ _ Q Z ~ _
<br />INSPECTION DATE f~ ~11~1 9 a.. INSPECTOR'S INITIALS ~ K-
<br />~ k-~-.D-~ria~,em OBSERVATIONS
<br />~-~-~n+ . c.-e-~.c~.~.c.c,-Ec~Q ~ ~ "`^ti'~,c'-~e~ °~ -F~ .h.-~".~ 6--~ a -13-2-
<br />~ T~ .~~d.~`n~'"~~ -f.+,~-~ ~,vt~u-fiev~ wa,a l~t~ -i_Q.~.eM ~ `e~k,uw~ ~eMO-h.+~c+;,~,'
<br />~ ,c,+c.~^^ bar~,v~ .~~ ~ .~vv\.u.~;v~ ~~ u~ut.a., we~.w~ +~ eg,en,a._-I~ti
<br />`C~~ wti1A n~,o .,u..c_ry ~ . ill, ~~ . ~'~"c!~"a..o ~ n~,~.cJt tlntae,o
<br />~M/a-'Z-~.c.,-~-eM . N~n.~M'"~`~ ~o,- kA,,,, n ~.~-~A.. c~~- -}ems ~.~,v~~, ~ } tom.
<br />~ ~'t Nvu~,~ ~..~,vt c.,c~0~ ~6-~ °` `Q.c`,~,r~.c_, ~~. ~0 1~.~,
<br />~ M.0 ~ a~NV~ ~~ wrh4 -wV~2.tc.~ onn.c~ ,vio nv~,c,~y~C ~q-(~-~,l
<br />1~6un _ ___" ~ ,~-~ s}~.C-~-un-c4 ~G~,~,c.Pn a.~t,,2Aun,e.cQ i-o la..e. a
<br />~~ I~~^~^.~--fi- - ~.-{~ un~n n~,o -+~.~.~.e~ ~ -tie ~'-~~, cR.~
<br />a..~ ~~
<br />~ -~^^~~, _+ c~u.cx., ,un'~,o a.wveM , ~ c~u~-}„e:,,, -(e~~u .~ t ~u+
<br />`~1~jLe-u.~-~e~ to -~.-~, ~-iM c~~~n'~-'^~-c~~ °^~-~tile~~-tn ~J-e,o~ Po.,~+ cry--I-~.c.
<br />amcl~~+ ~ r e~Nw.~,~-~-fn ~' .:w M.o+- f~9-w2`.clu,`,e~ ""'"",c., wu~n-~,
<br />~~ ~~ ~ ~ t
<br />I & E Contact Address
<br />NAME
<br />OPERATOR
<br />STREET
<br />/STATE/ZIP
<br />CC:
<br />5149E
<br />
|