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Y <br />(Page 2) <br />MINE ID # OR PROSPECTING ID # M - Qf(l- ~ ~4 <br />INSPECTION DATE 11-1'i-4~ INSPECTOR'S INITIALS_~~ <br />T,._ ~ ~ OBSERVATIONS <br />~ ~l~ -ti.".",-e"^ c,~,,~ d~-~C.cQ .cam l.~v~,o <br />P~+ <br />~ w.re. A~ x ,~ ~ ~~, ~ '~'~ `n `'ve.~Sl. m ~ • ern H a ~d-~.~,a„ o,,,~ <br />~aA ~~ ~'^rv"~ n ,~~,c~QQ c~.,~,c~, ~^~'~° ~ v X l D {-c~ 1 v~,'~uA iv <br />~~,~ ~ ~ <br />'~nn~.9. a- ~ ~~~~~, ~,~~~ .~~9^n 5~e~,p•,yt u•u.u Tl'~, <br />I & E Contact Address <br />NAME ~ (7 \^1~ i\.~ `-~\ 5~/1'~ I~'tA.~ <br />OPERATOR ~ . C € Q V ~j- <br />STREET _~ ~ ' U ~7 Y ~ ~ ~ r, / <br />CITY/STATE/ZIP ~I l (Tl~~ ~ (~ '7`) L~ ~)t~ C~ <br />cc: ^ CE C~ L, ~~ ~l}~,/~~ <br />^ BL <br />^ FS <br />^ HW <br />^ HMWMD (CH) <br />^ SE <br />^ WQCD (CH) <br />^ OTHER <br />