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f • (Page 2) • <br />MINE ID # OR PROSPECTING l~ID # ~ 77 ~~~ ~~• <br />INSPECTION DATE ~~ 3- /~ INSPECTOR'S INITIALS !'l~j <br />~~*~ ,~~,~ ~C~~-may ~~, l 99~ /Uo ~ ~~' <br />~/ , <br />~~ <br />~~~ <br />~~~ .~7~ <br />L,J,,,,,,,Q Zw~K VVV// <br />I & E Contact Address cc: ^ CE <br />-~ V "n / ~~ ~/~I / 1. ^ BL ~~(/ `~, , ~~,//~- <br />NAME ~~lj.C,(I- 6tin.~ti1N~/ ^ FS ~ 7 ~ Q~ ~~"( u <br />OPERATOR ^ HMWMD (CH) <br />STREET o1l(0~ W~ - ^ WQCD (CH} S,,Lt~rwmsil%~'.Y`"uti`E'~~-D, <br />^ OTHER 1,3~* E~/-~ <br />CITY/STATE/ZIP ~~CC~ Rroo3 ~~co <br />~ 8100 <br />