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' • (Page 2) n <br />MINE ID # OR PROSPECTING ID # M ' ~tis _ OOZ <br />INSPECTION DATE /C- 2T' !~ <br />1 J <br />INSPECTOR'S INITIALS L ~~ <br />/~l/s //c<sytgec,p~~- vr.-2I ri-CCl~E' !zf ~6>~L,~ /a.P ~lvrlr~nf lam. ~nri~ <br />Z uqJ l~ !telcM<~6<•prP~ Cf-+- ~~ rcf/e~4~+--, ~~P c~/JCr~c~aJ- t.~tC/ Ga~j o ~1 <br />I~lC~P a~~//~ /Clll~di~/~ i<. t ~/ a!lP,s1l~'//// fl!<P,t 9~/lztyyyJ f~ Y`cl~q~./ IC/'l tjLY c.~1cJ-S' <br />SLt<~6<.~" L'~/~s'{f ~~ C.~l•«• 1- ~L`p'' wr(~ '~(,~C ~rTY~i15•o~-v/ ~i Cv(~/{C w.~(S! <br />y~ r yn <br />/L<rf t1 !C l~J c~r ~ sC!/-e/ </_1LttL1`7r_'•//, O/~G~"rr OT +..'~~Clt, Q>~Orl <br />/ / / // 1q ~L / r <br />~~~s~/l IcII dPP~.- f~ack~i~{/ o~-~{ /6~-jt .,~~1/ ts•~ilr° p/~ f"~e ~.y, <br />A-+.yf !t /~ o'Y'Q/ljl~.., s ~oL~~~ (C /2 !!J / CK'-t.- i9~0ltlY;r ~L ~>y.-~ il~e <br />C•.Cr 7f„ PlA~ d~ /L,-Q /f<~• ~LiP ~,/SGl~rj f~~ /~09G.~~ GYQ' G!~/Lr:_-~ <br />..fA/bad ~a -~`F ~ ~ yn..-r°.~ /~„-~- /,r°f ~~ -fe-5~..,rJ.~/s~~.~ ~£,<.~C/_ ~~~~~ <br />/LLCM /fi/-lCr "eel// tf ~f0rl <' SC,/~ /t'j 12 ~~~~Yrl - /N./F J¢ltl ~fl/~--~ <br />t~cr~cp7-yz~.e~'~.C,~ J!~ ~~`e IL.rL« C'llC~/~" f CI/s~c/ 11.L l4~iJ-~ , <br />C (~ ~ <br />~ ! P J `~ <br />7~~-5 P ~ f ~.t. ~~~i !L<~z~v7~~-~ •~,. ~~v ~i-iz7~~ f 2~/ L/~~ e <br />5 itC ~ (tie f/ b S ~i~-~ ~7 X <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 />CITY/STATE/ZIP <br />