|
'~ • (Page 2~-
<br />MINE ID # OR PROSPE//~~CTING nI Dy#~ ~'fU' O
<br />i INSPECTION DATE b L~~ll INSPECTOR'S INITIALS
<br />OB ERVATION
<br />~i iv~~evtilK w~ ~~ 7 ~iV~Siv~,, ~ I ~ >~ ~~I-S
<br />1
<br />~V{.ov~n~"L r~~.C o~ ,1 b "d Vltip ~~k^'ti S, ~nX~ OH S ~'{'~ igrr~.~OV ~P~f ~ ~ ~~~
<br />{~~ .(~i,Z ,b`r,,ry,,,;{~~ ,[„~i~,,; w~i %te.cQi 6c, ~s rr. ~.ce~ 11~or~ ~'~,p~ ;•i,fnLt/i'l~i pv ~
<br />ww5 ~ rEf ecap ~t/vi ~ ~ (i~..~.atir~ a w. ~ 5 bvn't v ~It~/~taL
<br />i t,ivjavt~i,l.ti, r app ~ //
<br />n~"'1 ~ ~Gy ~ { 6 P~"l~ ~OP°~4p~j ~./vs 11I~-f.,,~~w3 ~.tu.~zaC~,
<br />-1 ~v li ~P.V fi~, C ~, rv P~"J n ~ r-'i ~'L , ~/~v'~i ~'~Ci w~.sU, i ~ ! cQi i 5 c.~..4.t-SL~i ""Ri
<br />ulav5 I~ilei~. ~h, •uP•Ztf'ioa.,, T'/ t1.~td~rov~..e~ uViyir..v~'7hy~ N/c~~
<br />~bru~ r:Tw#11 ~o t.,, wwf~+'" wkS ~S ~ w ~~ifv- {` ~;,,,5 1 u~j6 o k ~'~.Qi
<br />5 ~ /.~al~i, yGV~L SJw~b S ~ei ~,, cr-er,~'l~/ ~yv 'i "~' ~~'^"~
<br />II
<br />(aM.~, v hcQt,Rr~y t7/~) ~-o ./<.c uf.~r/i~~ ~C X15 t.,/w~'~¢,o-, ~i v~u-+~11r1 ~,/~5 ~~ "
<br />Gv. LI V ~i..G'eKi f ~ G~l ~P~C~I ~ '1 wC~ ~ u w~ /c~ ~~ s c~w~G (Y/ cv[c~`~P.(~` '1 ~ u~~~ i `~w
<br />~~ by{ ~ jjtl~o~~ rcvl u,tV- ~,~.~., y~6 ~./itwy ~i u/~vTT~v-
<br />~l/eIf`")L i1M0 ~ ~~7, ~vlS ); Ivt.@/iw~~ ~r~ 1'Z°-~ilsly~,S I~ /Wvln.~l
<br />ri(~kMi'i~ .~...,~ ke'1- 5r wtv~„ ~r t.J~lr' 4Le[~;~ ~w,{ col, 1
<br />P
<br />~ ~ ~ Lr~ ~~ is ,,;t- ~ s~~.~~.
<br />`~ n~c~t.- ~i l-r,,.,,Yk,Q~ ~ keo~ i~ wvure-~ ~o~.~, we.~.~(-l,.u-~„"`l
<br />uwf ..
<br />
<br />I ~ E Contact Address
<br />NAME K L~yE/ QB[L4EF,lM.
<br />OPERATOR ~-1}H' if1T€RJ~kI`to~AL lyG.
<br />STREET ~1 ~ ~ I~1 I S'f" G7- !JW
<br />CITY/STATE/ZIP (71~ ~FARKGR L/la- 9~ 33 ~
<br />-fie,,.,, G;U+q, bMlr
<br />cc: ^ CE
<br />fCBL-'~ Juttei Ld~ettaa+/-~'kG
<br />^ FS p ,
<br />^ HW pj~ IW G'vww~suw
<br />^ HMWMD (CH)
<br />^ ss
<br />^ WQCD (CH)
<br />OTHER -~1 („r,.,.,e.Pi ~j yA.~fl~
<br />ITV M.:M;~.,~ ih, f~U+J~tP/
<br />
|