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<br />MINE ID #~'OR PROSPECTING ID # ~"f`~5!"FC+~-
<br />INSPECTION DATE ~( 7'et ({- INSPECTOR'S INITIALS ~~
<br />~ ,,~~--~``OBSERVATIONS //~~~~~
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<br />NAME C~IELIAM V. yc~A7k ~)~ ),{~~1tA~d~~ ^ BL
<br />Ti~~~ ~, ^ FS
<br />OPERATOR ~~-Wu OF ~'. ~(~} ~iE1~ ^ HW
<br />^ HMWMD (CH)
<br />STREET ~+X ~ q ^ SE
<br />//ppp p~~ /1 ^ WQCD (CH)
<br />CITY/STATE/ZIP l-(-~~C'V ~V~ l,~ ~I~-~-C~- ^ OTHfiR
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