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<br />MINE ID # OR PA.OSP,E C/TING ID/ # rM~q'I-O0G
<br />INSPECTION DATE l/ 4~ /96
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<br />I fi fi Contact Ad rese cc: ^ CE
<br />^ BL \
<br />NAME ^ FS liO w'! ; •--~ 1
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<br />OPERATOR ^ HMWPID ICH)
<br />~j ^ SE
<br />STRfiET __ ~ ^ WQCD (CH)
<br />^ OTHfiR
<br />CITY/STATE/ZIP _
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