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' ~ (Page 2) <br />MINE ID # OR PROSPECTING ID #: ~ -~Q7-~(o `i' <br />INSPECTION DATE: Cr~jb ~`)k INSPECTOR'S INITIALS: <br />~~T <br />r' OBSERVnATIONS <br />~~z., cull-dR~-v~a~tar.a 4~2.~P N~d_.~ ~~ `~'~ <br />~' ~"~' I I 1 ~ e, <br />~ / "~Y~Q'~.,~Y~^~,~~I`1~" J S •pSe C,2'C~,cQ ~n ,~ C~-~(O~~ ,°^ ~~'1.09- ' ~- ~ai`~c/~~,,-Q^-xd V~+.P <br />JV Y~,~~""~ ~ v,~ ~~ ~ ~ c Pct (~a <br />3~ Q.~r~~~ (~ SlU C,~ 9..~ 1.~.,, ~~ ~-e e~ R'.°,"".~'~~ cr~~ <br />1 -~,~A cam- t,.3-Q~Q. <br />(Pg2~. <br />-/I Y ~ ~Ny2LN~-~-ALLQ ]~ <br />z ~ ~~ °~ l~ (.P a y <br />_. <br />I & E Contact Address <br />NAME: l~ 'v <br />OPERATOR: G ~-q <br />STREET: ~.CJ -~yDyn~ gp'c7~ /D pf' G <br />CITY/STATE/ZIP: ~.y/r,CJD~i ~~cl~o <br /> <br /> <br />~~. ~~ <br />cc ^ CE <br />^ BL <br />^ FS <br />^ HW <br />^ HMWMD (CH) <br />^ SE <br />^ WQCD (CH) <br />^ OTHER <br />