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~h (Page 2) • <br />MINE ID # OR PROSPECcTING ID #: M / ~' ~ O J <br />INSPECTION DATE: a - ~ ~'I'~ /np INSPECTOR'S INITIALS: ~ ~C S <br />OBSERVATIONS <br />~~ ws~ a °0 <br />-('~.A c,un~-..~' ~r,/~a.~.a+` e;e V~-~.~.-t-~a t~-~..~o-~.~ a-~,r4 -9-t-„^~-- <br />Gle~~~ <br /> <br /> <br />I & E Contact Address <br />NAME: ~ ~ ~I ~3 cc: <br /> <br />~ <br />- <br />C <br />C ~ Q <br />~+ <br />~ ^ <br />^ BL <br />ES <br />OPERATOR: <br />o <br />r..~ <br />~ <br />t s ~ / <br />~c~ . <br />.u.~. ^ H W <br />I, !L <br />k <br />~ ~ <br />STREET <br />U (~ 7 b ^ HMWMD (CH) <br />: r <br />r <br />a ^ SE <br />// <br />IP <br />%~~ <br />~ / <br />~ ~ p SO ^ WQCD (CH) <br />: i{ <br />~ <br />CITY/STATE/Z , ^ OTHER <br />