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<br />MINE ID k OR PROSPECTING ID #; l~~ ~1~1~!
<br />INSPECTION DATE /~ /3 _g3
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<br />INSPECTOR'S INITIALS ~_
<br />OBSER_~AT?ONS
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<br />NAME
<br />~C: JIt'1 ~`reuen.lS
<br />OPERATOR
<br />STREET __~~91 ~/a,LI Fntzdi/tl n121rIe
<br />CITY/STATfi/ZIP ~pLa ,~~n ~~/Q!/t1F,S ~n~ ddC~
<br />M: MIN\OES\ERN\INSPECTI (10/92) '
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