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~ (Page 2) <br />=~ 1 <br />MINE ID # OR PROSPECTING ID # hl -DIY c~V.~ <br />INSPECTION DATE ~ ~ ~ ~ S_q L{ INSPECTOR'S INITIALS~_ <br />OBSERVATIONS <br />Thy ~ rev, c~md~.~-~ R ~ ~ ~..~~/1 c,~y~ ~~W^/~ `~^^/t~R,c'}~'V1' <br />~b ~ ~ ~ 1 l-LO„e~n ~o.~ c~ s~v~ ~ o - ~ s -~ ~ f' <br />~i~n-~n~" c~~,~c~ ~.w, ,~wv,~2ec,-~.o~ wan ~'1 ~' ~ o~r~ 1~.~X 'r-wt Q~ ~ QC <br />~Q ~n,~.~ <br />p „"~ ,~ ~ ~,;.,, ~n ~-~ ~ ~~~- -i-~„_,, ,,,,,,fin-~ ~-~.A. ~~w. ~ ~ <br />-- -tom ~. ~~. `~ ~~. Cs~ ~ ~~ . ~~ ~ . a ~+'' ~~ ~- <br />c~.w~ ' . <br />u~d.xn,dna.~~ C ~C^~-'c~"~+~ Cr~.,~c. ~t ~ N a~-1~^ ~ ~ act ~- ~ `~'°,'~~.' <br />~~D c~c~~~'w~ly ~Jo~-K --~A~ tom- ~ ~ 3 ~ ~,,,,,~,p <br />~ `'`~ ~'x^~.,1° wu,n 1'`x'"'"1'-t^„¢~. ~9' S.,~~,vv~- `~'°~'`~l' -~^'~1 ~-t^-~ S-` _ . _ I ~~ i <br />-jam Sav -F~ ~cx,o~ C 6~/~~, 6{,-ti~. ~~--~~ ~"~- -.~n-1~ ~" S ~ <br />a 4'r S,~o.~, <br />I & E Contact Address <br />NAME y~~~r\~ H1`}` /~~~~1 <br />OPERATOR ~~ V C7" <br />STREET ~` C1' ~ (~~ I ~ ~ r' (~ <br />CITY/STATE/ZIP V_~~ C ~ dC~ Df'~~_ <br />cc: C3-CE ~Q-L ~ VJ~ <br />^ BL <br />^ FS <br />^ HW <br />^ HMWMD (CH) <br />^ SE <br />^ WQCD (CH) <br />^ OTHER <br /> <br />