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~ (Page 2) <br />MZNE ID # OR PROSPECTING ID # M" ~1T U-~I <br />INSPECTION DATE (p _ ~ O' 9 ~~ INSPECTOR'S ZNITIALS~~ <br />OBSERVATIONS <br />T~~ ~-~'ev) t~Mda.~L-(-c~ 0. 'pti~- Ul-~'~c~-(~taQ ,i,vv~,~2c~`K~ `~i ~ <br />--Q-I~I.C.Q/~ ~0.(~ ~ (~lu./~..~, ~ Q~U~,c~A ~ `(-~.~.t ~lM-8v1 Q.l~l9'~LR.-~ <br />~iv~'K^n-~ d~u~~ -~'~. .~~~ wu~ iv~niv~ ~(.tnc~,w~r.~. ~Q~ <br />C~~~~, <br />-M/~~-}-ceD -~~ Q-lscstQ/~ ~~~ '~e'v~d~0 ~,..i t~v.~. ~ww.~~<~ ~~t13.~ nAn^^.,ruecQ <br />.~9'~M -1-~'~l 4 ~c9. --(6~ - t~ a -P~~r~o.~ ~, `1 O_Q ie~nuo,~--F ' (~ Q ~ ~-~-~ <br />-~-,L ~~.A -tea ~ _~ b~~~-Pl.~~ c]/~~~ ~2au~cQ o,nnc4 .nom ~,c,flRr~e.~v~ <br />~~. <br />~`ru,.n .~v~c7-~ -1~-~ cu f~~Q ~~~ -~-f~ti,n orb -}t,~,~ ~c--4«~ .~:~~~~ c~M <br />-T~~.°~~~~+/~~ S ~SC~I~I-I~Q~v1 ~ O 1~'~-{-N'~ ~~!'4-° -~`~`^~`^'~~y ~(r`,~`~Q ~~(~ <br />/.e+.J Vo~4.u~ c~-~.e,-k.e~vt S~vw~p ~u~,w~ ~4 1 w~ ~o~" -~--fw,u,~`~ <br />~ ~ w~p .t.~~c. 3' S 1 <br />~~ --'~~Sb~ o-v~ -~ ~ ~'~ ~~ c~4-^M -e~~0(1M ~NVU~.n~ tM'~A <br />~ti,v, ~ -i- who d.^c~,w,g i1no'~ ~ c- /J.Un~c~, c~~~v1 ~ ~c~ ~~ ~~ <br />~~~~~~e~~ ~ .~n,c.,Q.~t()c~~ ~-~,cQ~~, ab cti%~~.c. c9-~^ -{-~P . <br />.~~zA c_-}c ~l ~I-k2 c~.t.~e~ w t1~.~.~ ~- ~1 S 4- ..~.o ~-~1~C~~~ <br />I ~ E Contact Address cc: ^ CE <br />^ BL <br />NAME ^ FS <br />^ HW <br />OPERATOR ^ HMWMD (CH) <br />^ SE <br />STREET ^ WQCD (CH) <br />^ OTHER <br />CZTY/STATE/ZIP <br />