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n (Page 2) S . <br />MINE ID # OR PROSPECTING~I,D~#: ~ "Q~ Id b <br />INSPECTION DATE: ~I y+f {~ INSPECTOR'S INITIALS: ~~/ <br />~--f OBSER_VgTIpNS <br />- ,~~E~l~`~ ~~.s n¢~teeP~,~te,up cud c~-~`f~l~`tnz~~D Ind ~( <br />tlQvuD ~ct~p~ ~~ sad, ~ lQ1-uu.~e.Q ' "'~' , ~ a c@0 ~ <br />I;u~.ce~ rnwn~ 4~ u'c aq ^~1~'~D~ 1~ ~ ~ <br />~~ ~l~ Qi( Q,~ ~1 (~i!(~ ~~ 13,7. ~ea.Qo L ~ Ir'~ ll~~~ A`~1.O~LC~O <br />~ '(tea G~ ' !'~ a~.~ r C~c~a ~ue~ia ~ ego c~ucsrx ~ , <br />wl~'tuP `M.~%+~ 'Pik U n~ unlz~.lraaL~u. ~ ' aC~ <br />Pn,s6~un~.Qf~ ~u P~e~~~u.~+, <br />-- ~ ~i.~+~+e~(2 Tip ~,~ 1:b~~~5~,cro. ~, ~+co ~~rv ~vu <br />~i~tt~ca.~1~ut.~~>n firma, ~, ~CUa~~~ lua,~cau~e.f~~ <br />I & E Contact Address <br />NAME: <br />cc: ^ CE <br />OPERATOR: ^ BL <br />^ FS <br />^ HW <br />STREET: ^ HMWMD (CH) <br />CITY/STATE/ZIP: ^ WQCD (CH) <br />^ OTHER <br />