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i <br /> <br />• <br />(Page 2) <br />MINE ID # OR PROSPECTING ID #: /~1 / ~ f $1_ 0.0 3 <br />INSPECTION DATE: ~(~17-0-0 <br />• <br />INSPECTOR'S INITIALS: G ~-S <br />OBSERVATIONS <br />a ~VJ-r.~,~ ~'+u /~+~/~a~~c-e-~ ~Q G-~.CZ 0u ~cwc.L <br />p/~- ~~ ~ l~ •V I ~-~+t Irv.,.-.Q C7 /i-o-...~r~l C~ <br />`~"~~ D ~ <br />~~ ~ ~ ~~` <br />~~ ~. <br />Cc - ~ <br />I & E Contact Address <br />OPERATOR: <br />STREET. <br />M e-w~ <br />cc: ^ CE <br />^ BL <br />^ FS <br />^ HW <br />^ HMWMD (CH) <br />^ SE <br />^ WQCD (CH) <br />^ OTHER <br />CITY/STATE2IP:C ro.._` ~i ~~ ~ ~ l8 <br />