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<br />(Page 2) ~j <br /> <br />MINE ID # OR PROSPECTING I/'D # ~-~ I-~~ 7 <br />INSPECTION DATE IOI~ Ian <br /> <br />INSPECTOR'S INITIALS ~` ~ <br />' ~ OBS~ ATIIWI ~~ f.~~ N ~ ~ ~ ,n _~ <br />~,,"N-~~:~ ~ ~ ~~ ~~ <br />gfitil~ ~Qr.~y~pt1~'I~LU.~~~ ~ l l~ u,5~ ~-~ <br />~ ~ ~~o o~e~ ~ anus ~ <br />~~ ~~a~ ~,,tan~ Eut~~~ p~~~~ln.u~~~1+~~~ 1~~n1n.~l~ <br />~1,'~f,L ~~ + ~~~ ~IUL~-6rid ~'1~u:~'.('?'t`~.C'.a~.c/~I ~a ~~CN,~ ~tV~'~~P <br />~,i~ ~+c~~~ae~ cvKa,~ ~Pi(n~o~ca r~ `~m-" Uru~ Mai n~ P l~~ EA~+.d~ ~ j ~ °~ . <br />~+~ '~ c~ ~~,-,~ -,irz~~ PEA c~ M~eect~tt~ Tlio s~ ~. , <br />~~~'~u ~Mh'~P ~IU~M Ah.euQ~ L~ ~~ ~u ~~~~ <br />I & E Contact Address <br />NAME <br />OPERATOR _ <br />STREET <br />CITY/STATE/ZIP <br />cc: ^ CE <br />^ BL <br />^ FS <br />^ HW <br />^ HMWMD (CH) <br />^ SE <br />^ WQCD (CH) <br />^ OTHER <br />