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<br />(PAGE L~ <br />MINE ID # OR PROSPECTI9NGQID #: .~7-J-.~.+o~ <br />INSPECTION DATE I-J ~'9'~" <br />OBSERVATIONS <br /> <br />INSPECTOR'S INITIALS <br />d~~11~a~~Qa V 0 (/ <br /> <br />I b E Contact Address <br />NAME <br />OPERATOR <br />STREET <br />CITY/STATE/ZIP <br />5~49F <br />CC' <br />