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<br />MINE ID # OR PROSPECTING IDn # Nl' $'I -1(o S
<br />INSPECTION DATE ~~-aCl `~. Iy INSPECTOR'S INITIALS J~S
<br />---r `rDG
<br />OBSERVATIONS ~^ !
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<br />I & E Coldt~dct A9dress W,It b{ 5~11r.1Flit Gfµ dtd W~~~1 oc~ ^ BL
<br />NAME ~F'{.,S M-A, 1 1 ^ FS
<br />^ HW
<br />OPERATOR ^ HMWMD (CH)
<br />^ SE
<br />STREET ^ WQCD (CH)
<br />^ OTHER
<br />CITY/STATE/ZIP
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