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<br />MINE ID # OR PROSPECTING ID #: (V~- •'~, - ~~~
<br />INSPECTION DATE: ~ ~l ~ I 1~
<br />INSPECTOR'S INITIALS:~~
<br />• OBSERVATIONS
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<br />I & E Contact Address
<br />NAME:
<br />OPERATOR:
<br />STREET:
<br />CITY/STATE/ZI
<br />cc ^ CE
<br />^ BL
<br />^ FS
<br />^ HW
<br />^ HMWMD (CH)
<br />^ SE
<br />^ WQCD (CH)
<br />^ OTHER
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