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~~ <br />(PAGE ~) <br />MINE ID # OR PROSPECTING ID #: ~ - ~ 3- L~f L - _ _ <br />INSPECTION DATE B ~l a ,~1~ ~' INSPECTOR'S INITIALS LL/_ y <br />/,,, /'.,,' L /1 ~r~ OB/SE,~RVATI~OlNS / ~T7~ <br />!~v`c /D/ /N~~fC.C ~X p~~-vvi v~ ~/LC!~ L"s~d~i /Y~vne. ,7C~ti[.v,~ . /hy ~2~m <br />~aLrn~a ~,Q ~ G~~ ~~2 K~ ~vL°".O ~L9'7~L, ~~aC 6~e/ ~2 L-ri-Pr/ax,~ <br />~&run L'-~M.G~ Q ~/ a~f~..,.~ ~/ 43~~ j~ _ L_Z~ J .G~Ou/~~ ,fee ~1~t /rte: Y2.a-GCS liY/ <br />Yjte C - ~/~1{Gh t~~Qf,/l//rI7XA/.yGG~LE' (/!/lX /~G~7 G~'~`R' ~in,,,Qn~(/~'~.LC 9`'~.Z_ <br />(Cn' t, ~,~, s,'~/N/~' 6~^~'j~ G'V/ip %~O/ /~2L ~te.• t~sJ'~w~ ~ / ~ . <br />`~~- LV~L ~{/~JL 7F tf- ~!'r/wT ~~),(,LZIU'v~LJ 6T~w~u'/a.Ll~ Yf1.1' /M.C.~.~Cr/LLa~ <br />GA,1nDC SL~iR. `~cr-u.~~~.q Sp//~~~~ L~ a-Z2a. G~d1~/fir{f~~ e, //•'^. r , Jc-Sf-ze,v, S~+~G^~c~ /7'lr. /~e~,~zx.a~.~ <br />tY- /d'l1%I'1~¢/L(_(j (/Y •LQ~• V • lc^ NUl~G~7~'O~/~~ ~~''..L, ~L ,C(~D /rli ~. Ll`'.L'C'~ C(/77c~ <br />~/~~rr/~y~ocz~ ~~/p/y. L/L-ricCl"i L1/t.~(? /_tc ~~~au/lc Gvgv~s~ POLS/S6 GL/CCd'c~."vq/~o <br />/~I/: ~~-'~'"'~"'"~ Uy~ YC.vr.~ O'Yi/Lc S.~n G/2°c=1 /(yt c.~l C~{,(is/ ,,E;e.:t !32.:E i2c-f/ _ <br />C/~,~'-- / /A J,, / / /~ / <br />" ""~"`q Q-r 7r^'~ L~,,...tiz:T.c.~.c,E- TJ vG.~ ~~, ~~ ~~ r2 ~ ~L~.,2--`~ Srci.~ <br />~,(~ /~ Lcrt2Lecf c~~ //i~ L~~~ ~/-~.-~ ~~c~i~u ~ ~ ~ ~ac~~irr^..~C.~ <br />Ct,.~ /J~-~o~ <br />7 ~ ~i~~~Fc~ ~ Cc._,~-/'XUG4GrStPll~i"S~it,~- ~ aL~r~T~r- <br />0~,,..,~e,.. ~/ / ~lJ sc,•~LG vr+ -YC /~ n c c.~ r~' /I a L o r, . ~. /~ ~ <br />I & E Contact Address <br />NAME CC: <br />STREET <br />CITY/STATE/ZIP <br />5149E <br />