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<br />(Page 2) • <br />.MINE ID # OR PROSPECTING ID #: ~ 9~-O ~ I <br />i INSPECTION DP,TE: /~- 7- ~ 7 <br />OBSERVATIONS <br />I & E Contact Address <br />J <br />OPERATOR: <br />STREET: <br />CITY/STATE/ZIP: <br />S'ca~t <br />INSPECTOR'S INITIALS:~O <br />cc: ^ CE <br />^ BL <br />^ FS <br />^ HW <br />^ HMWMD (CH) <br />^ SE <br />^ WQCD (CH) <br />^ OTHER <br />