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<br />J ,; (Page 2) <br />MINE ID # OR PROSPfiCTIppNG ID (#~~--~~-'a'~~ <br />INSPECTION DATE ~ I~~ 19 ~J INSPECTOR'S INITIALS <br />-e~~~ -n-~~~ a~ ~-1~~NSU.~ ~.,h~~-~u I1~u.)v~~ t~ c~'~.ttit~ 'w1ko.~n <br />-k~_nc~ ot.~.ce~~t-I~, `aR-~~ .,.-} '~C','a-~,o . _1~^n'e~.',~2~t'~ -}-~,~e H--~~,,n~ (~~1 <br />C~~Q~nti-{- ~ O ~,.-}~ ~~ ~-I~-(~~~ -{-~ ~.uti -}-tom c~.~.~,~ I~~cc <br />~-~~ <br /> <br /> <br />~q ~ S -(ut ~ ~~ <br />~~~~~~ <br /> <br /> <br />~-a.~ ~f~~tu~w.~ S~~,~-hen c~S~c.-I~~n '~~ <br />.~i~,~c +w~~M~B <br />~~ . <br /> <br />~rnt.-Ec~. ~} 1 1,J1~,a ~x,~~l' <br />3 ~ 3 ~ ~ w ~:tn •~;o c~~ <br /> <br />s~ ~ ~~~. <br />~~c~ ~ ~n~~~. ~~ -~ <br />2 ~ E Cyo~n~tactA~d-d~rpess <br />NAME 111 ~ ~ \ (1 1~1A/ <br />c~..SLc~ w~-~-~ ~,~c-K ~ m~Q. ~1~~ <br />eM-1{~.~ ~-Xo/~f~fM arnc~ w~cQ,~dn i.~n~ w~Q.~~ <br />~2~,~-1re~Mn M.c~-kd2. ~a~~.c~Q, <br />OPERATOR l ~ ~y~~~ yn <br />STREET ~ n f~~~~ ~^ /~l 1'\ 1 r f <br />CITY/STATE/ZZP \1~~~~1 ~~1~1~J <br />cc: ^ CE ~~~ ~'~'~.Q <br />^ BL <br />^ FS <br />^ HW <br />^ HMWMD (CH) <br />^ SE <br />^ WQCD (CH) <br />^ OTHER <br />