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_ i <br />' ' (Page 2) ' <br />MINE' ID # OR PROSP©©ECTING IpD1 I# /YI - ~~ -.~ U,T_ <br />INSPECTION DATE CJ I C~. , l 4' INSPECTOR'S INITIALS~~ <br />OBSERVATIONS <br />'~ ~ .D-~,~r~..ati.gM c.uv~o~.t,~.c,~1-taQ o, ~sw~~ux,c~~.a~n -i,vv,,~R,c.-bc.t~ ~ ~~ ~ hcvll. <br />~ } a+ -~.c~ -fix, ~.d.,~ ~ ~ m ~.-~.Q, laµ~A~,~.c~ `,~,° ~,, ,,,, <br />~~ Gp~a,,,,~Q G ~^i` ~ P°^-~ a$ -ft~ ~•~$e~tc~-a.in ~tu~Q <br />~ -H"-~ ~Q,~,~ ~nxtvuL ~~ 6~v~-~ `t~t- `~" c'-'-'.~2,~1`~.eQ <br />tM~p -~u,~~~.~,~n ~, ~u~ `-~ ~,~,c-~ /w~t,u,ti,~4 -t-ti.~ ~„~n dom.. - ~,cuM <br />I & E Contact~Apddress /~ ~ ~ /~. ~ (~, <br />NAME ~ 0 H.^V ~~p1Ti-^l~ TtW ' ` y <br />OPERATOR (~~ C ~ Q V \~`T R <br />STREET 1~ ' C~ I) (~ X ~"I I <br />CITY/STATE/ZIP ~-D <br />~C: ICE C~-~- r-'1 ~~ N <br />^ BL <br />^ FS <br />^ HW <br />^ t~1WbID (CH) <br />^ SE <br />^ WQCD (CH) <br />^ OTHER <br />