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<br />MINE ID # OR PROSPECTING ID #: j"(^ g7-(~2.(0
<br />INSPECTION DATE: ~ ~-(Z-pp INSPECTOR'S INITIALS: !/U
<br />OBSERVATIONS
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<br />I & E Contact Address
<br />NAME: (J 1 LL ~'Q ~-~Q.(~
<br />OPERATOR: „p Fj ~~(,,t~-Ri2.t~~S
<br />STREET: a'~]e ~y ~ S-Y-jj
<br />CITY/STATE2IP: C~QJ~~j ~'-'~' ~ ~l ~-f
<br />J~~s S~ev~r
<br />cc ^ CE
<br />^ BL
<br />^ FS
<br />^ HW
<br />^ HMWMD (CH)
<br />^ SE
<br />^ WQCD (CH)
<br />^ OTHER
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