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<br />(Page 2) L~sjj <br />MINE ID # OR PROSPECTING ID #: /-'[-l q~s - ~ t~ <br />INSPECTION DATE: // -Cj- G / INSPECTOR'S INITIALS ~ ". <br />i <br />OBSER <br />Mr• !Mo %l e .f~rlA 7~ca;]~ yL e d ~~ ~cc ~t ~t~.~ was' e ~t ~~,,~~ <br />rca~tic!/D~- s~ u~t.~'~/ 7~-e n~ ,~f v~e~r~ seQlo~. He r~~ ~~Y~.~ ~~a~ ai'"" <br />~P~~-~- w/a`f ~l~ ~ozo~/~7L~..,,,LL~~~~[~e~~ ~a~f ~~fe real be~pa~l~e ~'~-e <br />~/w~L~/r/l¢'~-] wtlfJ {/~ lrole~yu~GEp JO 41~~ ~b~_lv//~ ~ f't71'"`"'/ <br />/-2I1lzSYl1~(~Q GrP~~ G/~l/ LI~.C~ /~ bLi~ a~/v ~A '~t~ G/'t°PjJ[ ~O <br />~Zi~e //1~-r f a~x ~ ~ t~-.~ u ~ 7~~ ,pry e~~ . `~-e~r ~~ ~I <br />Sul ~~ mil{ ~- ,K•a w <br />/ f P <br />o ~ ~Z•-2 ~~¢~!~- U I- w~~ yt-w.(/~, /L Grl e~~~S/~ w~/ aTr/ vt u J cz ~iJG~,~G/C~~~ <br />tU ~"I""~ I ~Lrvu ,<>° ;/~N[ CN/L~ /[~~ / P 6.Q. ~ ~~ 4 1 <br />hr ~ `~~~ <br />ar ~ /~~7~le r+~-orb <br />/k e lhS~l~it"f ~(A ~ ~ ~ "''~ tip.'..-e ~- ~~`C e ~/~a~ r~ eGell~~ t <br />e<<srdr= <br />/yts~~~ ll~--e// su-~.-~~ o~ zou2, un~. cc (rPSx Imo, <br />/~~~ ; i ! o~o~s <r~a~ '~t~ ~-e a`,~riN- ~t iu fa-,~1~~ wtfGr,~~ <br />~,c~ e11 j^K-~ ~ hdy+-y ~~-. <br />~// ..ry~Yl"tr~ //"',c~ fJel'!.-c~7 ~!l <Nla,~w/ ~iftu~Dc~-~cf w~2f dr/~ ~r at~Sely~ < <br />/vo olr~-y pl'Y1171.1yr.rs L/~ ~ l/ <br />7-l~ !f sL rd~ Q~NLoG~I d"f~ M~,H,N~J ,-fiE~~OI' Or/Sd6 ~ P~IP,?~1~'t/ <br />i"P61-k- 6~ 1zBX'f Stc~r~,~•¢~ r~,~ vlv~lcl~-~ ~ ~Yh,~-¢l~s 2~ <br />nf~oLar'' ~ ~2 n/r.lKii~q o~~s~=. <br />I & E Contact Address <br />NAME:_ <br />OPERATOR: <br />STREET:- <br />CITY/STATE!. <br />cc: ^ CE <br /> ~^ BL <br /> ^ FS <br />^ HW <br />I ^ HMWMD (CH) <br /> ^ SE <br /> ^ WQCD (CH) <br /> ^ OTHER <br />