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• (Page 2) • <br />L <br />h11Nf ID # OR PROSPECTING ID #: ~/~- Q~'- D~~ <br />INSPECTION DA E: Z '(9~Qn <br />OBSERVATIONS <br />'~rt S w 2f CZ <br />Pro~~.I ,{~° , <br />:' <br />~~ti~ <br />INSPECTOR'S INITIALS:~~~ <br />~/(t/d+/ a~ sh-atc(~ Cwy~'~ir.-1'"' ~~ L{riieYk•r~'-2 pL~/~+~~Y <br />I /~Z o~ `~ P / - GZ(/Z - 8~ ~~. y~~l~r-~ re`'~~s~c ~~- <br />/QiG~K ~/~, IQ.a~F_ acco~Oss~r~ ~ . <br />~I~d~ry,-. ~i,•-~~~~ red' 7~~ o/~ ~ re~~~~scc y~~ 6°"~`~"~" <br />~-a~K-srt °~.csT,~ 6y ~ ~~~;2`'`dr J'' ~irl~ goy-~~y-l <br />~ ~, ~~ •~-~- ~ ~e D ~~ ,~.~ ~ ~r sal (p <br />f / ~Q Q <br />~o-f~" fo <br />P~ 7~ e ~ s ~ ~~~~ ~~fi~l f <br />ores wl! tee e or~r 4" <br />6 ~ ~t'ettr~ ~j~y d~'D~~r <br />~~dl~ fz.~o Z~ t ~-e, cz~ . G fo ~~a~r, ~C~ ~r~'f~L <br />6 <br />1'G rrec~ .:f ~cp~ d° ~ sG ~~,~G~r~?""'"' s~1i`,~' <br />I & E ContactAdcress F ~ "" n~ ~r (Z ~~ ~``~Z"Gf ~ ~r <br />NAME: <br />OPERATOR: <br />STREET: <br />CITY/STATE/ZIP: <br />cr. ^ CE <br />^ BL <br />^ FS <br />^ HW <br />^ HMWMD (CH) <br />^ SE <br />^ WQCD (CH) <br />^ OTHER <br />