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' • (Page 2) Ij <br />MINE ID # OR PROSPECTING ID # Iv/I/- ~G ^ l4 Z <br />INSPECTION DATE /O - 2 7-~y <br />• <br />INSPECTOR'S INITIALS Z~~ <br />~~ L . /L `~ j7, z7Z~j t 1 tt/f~f'ar't c4~~ ! 2 .( 1L 1X t/~JJ ~ ~ / <br />/L~t C SPL /t-r~ ~I-/z7/~ ,~S ,e//% !1 /J~ ~ /'~'J f JcC~O ~Gts. l!<9"e'e~ [aee ~C~ <br />b f P!c-,~, e~ p~ ,, ~~`~ ~c, `~ ~~~ r-~~ l~c,~-2~~ - <br />ty` ~~,.-e `Iy~ K-C C~G/e.a._.,'T~ ~{ j. t ~ /'/~ loi .~ / / I ~/GPj ~~ R/~ ~.L>~ <br />/~Yl~ /CAE ~rd,P-~° ~,1~-sr•c~ /7~KCS ~/'7i f2liT bc'e1c i~~c/'I[~~ !t~`t~cY~-- <br />5C4:-cN fTl,c-(' .~~s.-cP ~of7f /^-QrQ ~G^i'O-PTYP~ ~'a~ h"`'esy Jcu~i'1~ /s~'t/~ <br />ff ~~~ ~'z'-S-/~<c.~a•-i S1`llK~~l~~` ~iL%C/f ~~•C'~ L«^~~ wlT~` T~~e <br />!(~J'Z'~'Jh-z2~ ~-r~~~'/i~ !d/H-.-~s~fCr'"S LvecS l«<cle~ss~ ~~~ ~ <br />'~~~ z a <br />~-,o <br />sf~„-- ~c/.~~,- ,G/j~l~~,~ ~~,~ ~ Sf,~- ~t--~~~.~- w~~ ~~ <br />oC~°~,s•. t'f r/~y ~ ~ F~<[z't •P 7/~e e /,Z.Qr,-c f ~-i G~ ~ c Cx.l/C c ~ s o'er` <br />R eucc7//~/°~~p~i S/P~ t(~e0• ~ce ftY~~r~f' /J~[i'-t~• ~ c•'C=s~,~ <br />~)'7L.-(~(" P~I~ h~c~/ wCZCC/.~1I P isL/4-`c~~n~/" ~r /~'~~~~~\ <br />w~ilc.£ c~ty'ZC'1 f/l~J )'I~~Ck li, (f C~stf - J~h~,Vn !X„~L'~`x~`~"` J <br />I & E Contact Address Ce: ^ CE <br />^ BL <br />NAME ^ FS <br />^ HW <br />OPERATOR ^ NMWMD (CH) <br />STREET ^ WQCD (CH) 5d.~~/`L (1lYli {.rOw <br />CITYJSTATEIZIP OTHER ~.,~ fT[,,.l.~l <br />