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' • (Page 2)/tj, <br />MINE ID # OR PROSPECTING ID # }''I~ SSA -O`~~f <br />INSPECTION DATE I ~ -, y.~ <br />OBSERVATIONS <br />• <br />INSPECTOR'S INITIALS~~ <br />STS-.- eve <br />it/ O ~t-~ ~~ G 4 r ~.5~.. ~ w~ ~~s'~~~. f~Gw/~r4/~~ ~ GC ~Gl <br />fig-~y.t ~~,~-, e 7~a op~ve ~/~~~../~~~ O~ ~wt~' ~G,~e <br />I 6 E Contact Ad rese cc: ^ CE <br />^ BL <br />NAME ~~ 0 FS <br />^ HW <br />OPERATOR ^ HMW1II1 (CH) <br />^ SE / <br />STREET _ ~ ~. YIOX 7i~ Z ~ WQCD (CH) ~ ~/~ S`+-~ ~~~~ <br />ITY/S//~T`ATE/Zn~]IrrP__ ~ ~ Q Q ~ OTHER ~"~~ S 1 t,~S <br />