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<br />MINE ID # OR PROSPECTING ID #: /`/-/~f$Q - 2 SZ
<br />INSPECTION DATE: ~ - /d - ~/ INSPECTOR'S INITIALS:~~O
<br />OBSERVATIONS
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<br />I & E Contact Address
<br />NAME
<br />OPERA'
<br />CITY/STATE/ZIP:
<br />cr. ^ CE
<br />^ BL
<br />^ FS
<br />^ HW
<br />^ HMWMD (CH)
<br />^ SE
<br />^ WQCD (CH)
<br />^ OTHER
<br />
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