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<br />MINE•ID # OR PROSPECTING ID #: F'l- Ig ~~'S4'~
<br />INSPECTION DATE: ,3 -~-~
<br />OBSERVATIONS
<br />INSPECTOR'S INITIALS: J~
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<br />I & E Contact Address
<br />..~teS ~U~s$
<br />NAME: 15,trnn[S:QRT SY7~CIG // f-G/},R k (yQUfS cc ^ CE
<br />OPERATOR: 1~,.~ ~d,7cLfTtlJ C_, , C_, ~ : ST~~ ~ ~~ ^ FS
<br />rO~~ ~~~' ^ HMWMD (CH)
<br />STREET: ~ ~ ,3 ~ ~r~,~rQ/{ ~'E'~-~~++ ~Q- ~ /n~ p t 3 13 S~Le:f2~~(~ ^ SE
<br />CITY/STATE2IP: `~q~ /e1~-I12~ C~~,If((q% b. Ol~fc~~ D2a)(1PJ2 ~ ^ OTQHER (CH)
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