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(Page 2) • <br />MINE ID # OR PROSPECTING ID #: <br />'Y~' <br />INSPECTION DATE: R'" a~ ~~ INSPECTOR'S INITIALS: <br />OBSERVATIONS <br />So t ~ t,i N~ ~t w p ~ttct~vtd~sT ~~ rr~so o t~~~.v ~ ~ ~ ~.a~ <br />bw~~S Q (Lug (~ ~ Sot ~, ~ rt ~ Ri c..L `~~-p9vt~.~: O t~$.t~v ~ <br />f~10- j- ~ ~ ~ C ~ t ~l t S t D (~, <br />~ ~Rt~ '~tSCu.sst o <br />G~~ ~ "IY1 ~ ~ C D ~~ fZ w~ Pmt ~ -fiol ~1 l..gm6~nl 1 <br />~irQp i N o- ~ ~ .D ELa ~ ~R.~ O fz -}~n C Co t1 c Rb`[~cT '1-t fH- i g fiD 1ot~ <br />`Pc~e-~ ~-bD~~ Trt~ r~~ r-t u~ c~ ~a~~c~-~oo~.n woR ~.I nceTs. <br />`~ E ~ , .c c s ~ o n~ -~ ~~.rn e~ -t-v, ~ o Q~-~Q' s n--~P ~5~~~~ <br />~~ ~ W ~ U t~S R 1_t_ -t-(n ~ ~RRm Ftdc,E 5} EG `F r Ct'~I O NS <br />~Q~ G~, N, (r- -F-a 6 E ~l~-t ~ S fM't c~ 1 H G ~ ~ ~ i s(o N W i LL ~ 01'' dtoj ~i <br />L~ r~^f-, ,~ ~ -~ ~ ~s,~ cZ`n o ~ -I-o tvl c 110 ~~-1 LR-~SJ a n1 p,R~4 <br />~~ ~-tn C p H (t~E 1Tl o P~-P~t-~onl ~ ~ E ~t~ N r~-v..L fZo ~-~ 1 s <br />~ ~ pc~°r-~~= . i o p s~ t L Bonn ~-tC u.pPt~ S ~uhu~ <br />~ Q.~ F~ kS ~-u ~c~ ~ <br />`g alt SfiOC k Q ~ >~ f't ~ N U ~ ~ N0 R.j~-( S L cD t~ d 1= <br />'Y~ ~ t~~ • ~~~-Pt~1~9Z S`fi-rctt~ -}in'14~~- 1~ l.~l (l.C, f~~ M OV ~ <br />I'~ ~tSZM Irnf c5~t l L.o C.~- f--t o~ tF S S oo n.f 1t-S -BOSS t 6 L~' • ~, <br />~1 C ' ~ (L€~ QE M c~~L tt ~. O ~ ~f2--P~-}-~ p oaf ~l ~tv~, t~ '1~1 ~ R.~-V1 LR.t~ tiJ <br />~l~r LJ fC-S C--c~l.-f-i iV l~.l ALc ~ 'N c~ Mt$~o ~, ln2-o ~L51'1'~ 1~'•0"~ . <br />S'f°~.."'~ w ~-t~ m mgt ~, c~ i } <br />~ -Pr ~~ ~rN ~ 2 -~v~ E" P~a~ w ~ i c N t T-c cu, <br />sty rvt PS ~ ~ ~ t-~-c.N ~ w ~ P2O ~~~~ P~-e.~,.. <br />I~0 V1'1 tYJn)2 /~'~ D b L-b`Y~1 /l,! 0 ~~p • <br />I & E Contact Address <br />NAME: m 2• ~ L f7 <br />OPERATOR:~~n ~ l i-~ <br />STREET: ~ ~ f~ ' n (>>C ~ q <br />CITY/STATE2IP <br />cc: ~1 CE3'~~S <br />^ BL <br />^ FS <br />^ HW <br />^ HMWMD (CH) <br />^ SE <br />^ WQCD (CH) <br />^ OTHER <br />