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<br />MIIQE 1D # OR PROSPECTING ID #: IyI 77 -~ Slo <br />INSPECTION DATE:g-~~ -~s{ <br />(Page 2) <br />OBSERVATIONS <br /> <br />INSPECTOR'S INITIALS: <br />~ ~ kJ~ q I ~ d ~- W'~-^'~`'~ Guco ~o.t~n-e0 Gg Q ~ ~ 07 c. /~...~ <br />i(/ 6 tv~~...i <br />I & E Contact Address <br />NAME: l~ rj ro-,~,_y 7 e.~'7~~- <br />OPERATOR: ~ra22+~-o~C.e,~..-..fin ~'/~i-~~Iw e~ <br />STREET: l~J~ duo x_ 9 <br />CITY/STATE/ZIP: ~7~p~...,, (.~(') ~ ~{~/~D <br />C~a.~.e IZii au,.,,,7~- /~ iv7~ <br />cc: ^ CE <br />^ BL <br />^ FS <br />^ HW <br />^ HMWMD (CH) <br />^ SE <br />^ WQCD (CH) <br />^ OTHER <br />