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• (Page 2) • <br />MINE ID # OR PROSPECTING ID #: Ili" ~ Fj- Q~I <br />INSPECTION DATE:) l ~ INSPECTOR'S INITIALS:$~ <br />OBSERVATIONS <br />~ t ~ (S t o r\I L0 ~l.D u.c-}LSD ~ ~ ~ ~ ~ ~ 2t nl U- LTS.S Q rsz-1 i o N <br />c7~= t~ ~ s t ~ p ~.1 31 a'~~95 ~ ti. ~~ k.S. ~ ~ Pr{Zc~" ~o~s~u~++ncc, - <br />~i~~~ ~~5~'cTcoNS• ~~ stTL: ~s -Pr Sn1rt-t,1, ~23uoEs m(rc~~~ <br />p ttt~N 4~Cft'R~ PcPP'I. t/~ Mi l,~ ll~ ~-r0 ~ c2\PP~t CIZf'2"l~ L~Ce)Kh-Up. <br />~- ~ o~ i' ~ V. 2.-l f1 CT -stn ~ ..L~.t SQ ~-\ l ~ 1~ U..) t~~ QYt 1 S S ,S l.~~l. L`SLI ICJ ~ ILL O F <br />1-~ C 9 ~ •1 1 s t p t~~, fi•~ p M 12 ~ m ~ s ~ ~ 221 tr r Cf/zr4 -t 11t'-'t ~ F I~ ~ goy s <br />YY1 I nt t N (r- C..c~ • i~ a m t r\c, t rt_ ~ ~ ~ 1--4k ~ me ~, P ~Prc~ ft--~ •Nn ~ t 1rn C <br />~~ `'M~ ~SPt~-TIN ~ 'IYIc ~n1ft2~ s( IL ~.D~S-fuRBc`D m2~ O~ <br />L~ $ -Hn Pr oil f ~ c (z cs' ~ rF S ll~(S ~ ~.- -~''~ ~ N c ~I i ~ l (rf-~ c.J ~~s <br />cJ /1- S N c7 tG`~ ~ ~ (3 2 I tf1= <br />W ~-CS 5 -tA-B L~ H-r\,t 0 N p P i2o to Ltr M <br />F I /s ~t-nc cl ,t-c ~ /'h2~~"`t p R <br />1~ ~ S C u SJ I u N A- la o tt-f' -tom C N C~ _ /tf P 20 I~ R ~ ~ ~ ZM s IA~d~2.+~" <br />1/r~ 0~~12.1't'fi7~~ W 14S hC~-~ ~.~ ~'C <br />~2ou ~-,D o~ ~ ~-- tee L ~ P~~ 2 5 ' <br />s l c~-~ s ~ m ~- ~~s ~~~ p IZo ~ ~ ~y ~ I s P~~ ~ , <br />I & E ContactAAddress O <br />NAME: )lt~•'sll n GF-14"N/f"Yl~ ~ ~~ <br />OPERATOR: ~ ~ ~~~/ ( M / Il/ / A~f~ l~l / <br />STREET: ~G-, f L-• ~L-`~LO/~=7T S~f1~-f-`ts/~ ~~pl~ B~~`(-6 <br />CITY/STATE/ZIP:( ~PLI-- t^ ,~/~ _ t~ X`Y.3 <br />cr. CE.,)~~~ ~~~~~ <br />BL <br />^ FS <br />^ HW <br />^ HMWMD (CH) <br />^ <br />^ SE <br />WQCD (CH) <br />^ OTHER <br />