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~, ~ (Page 2) Z~Z <br />MINE ID # OR PROSPECTING ID #: ~-I ~Fj ~ ~~' <br />i INSPECTION DATE: Z Ov INSPECTOR'S INITIALS:~~, <br />S NATIONS <br />1~ ~/ j1 1 <br />~ Gr.~J.[~( '~~ 'fir y5 Ga ttG / l y .L ~r-etG a/-e /FEE 5'eGc r ~.~rf ~~l <br />G~t~ !•!'+~ ~ W~ e~H7tl~~ZiI~/J-~- f1~7JLdSS. <br />wI~ ~//-e 9~iyv~f v-f- 7~ -3 < ~t rs ~on~ ~il- ~cA yr-r.rx/µ..lcw•- <br />dcsl~Lrba~-ce a~ !SO a~/~ej ~wjv-Q~ ~ ~/~~e ~cs~rr-~.~cc•t <br />~t~ c s ~Ya~~~e.:lc /iz /~`~~~ nG~,E'~jf/~~.,yzu~", rt~l~ye~,rcP~ <br />l S~ Q~r~s , ~ e jio~^~ s'G~~" /vim 1-~v~e~.. /~ ~ f~-~ <br />f/ ~- e , <br />~,n9~~..z.z-s w~ ~v~sp <br />e 1,; G ire ~/f ~fy~l~6rz-ce r1~',-~~-~ ~! H-..~~ ~. ~~ r s~ f/~r ~s <br />//1fy~m'-f !n !vim /~n~ Q~~l /</L~-~[ Gf ~/~lt~"~l~le 5~~~ <br />Q ~ `/r <br />Lv~p p'^z"'~s` ~~ f F ~ <br />I & E Contact Address <br />NAME: ~j-ic~ vr_ k ~K 1 [/GC <br />OPERATOR: j.,i,!~/pl-~ ~' G~jE~B s~if~t-~r-re_ -Zs-e ~- <br />STREET: / ~9~ Gt/ JZ~s ` /S+,~P _ <br />CITY/STATElZIP: ~~~1~_TC_Ge ~G21'~ <br />cc: ^ CE <br />^ Bl <br />^ FS <br />^ HW <br />^ HMWMD (CH) <br />^ WQCD (CH) <br />I~'OTHER <br />r».- s rves~s ~ bKC <br />