|
• (Page 2) ~
<br />MINE ID # OR PROSPECCTING ID #: /"` ,~ - 0 ;~. rl
<br />INSPECTION DATE: / ~ ~ S ~~ INSPECTOR'S INITIALS: G IC S
<br />OBSERVATIONS
<br />~ ,
<br />-ems . ~..~ ~~ ~ ~~ ~--~~y.,-
<br />`~ `"~" ~ ^.e' e,e-i-y"' Zycw~`'2r-h ~,- c-'~-~d~M~l~'' ~j N-~«ti~ ~-C.~ }2l~-c~cvc'~-/
<br />d ~ Q~~ -!~ o~ u+ u,~lZ ..tom-,.. .~-~.~L' ,,~.
<br />~Vn't [l}uo It•b N1+-.~ ~"'~'~ -~,t ~s~-~.o ~J / _ _ a.L D~2' O
<br />~'''-fl •~ f~-0• Cu.~u+,~~~L.~C6;....~:-c~h ~~1 ~~~-S~bt~Y't~+anr,GlA/! a~,..0~
<br />-°.u-rt-~s+a-'-~- , ~'~`-! O'~^1^+~-Th, na`-t-~~`'3. ~-fl .a-~.~.u;~ c1 rYla~ ..S~GCwi "~
<br />-~ ~-fl"~+w'~ an.4, r-uD ~ /~ ~Q9-~-~`,~-..,f s ,4 ,~'9a- e-~ r7 ~""~ ~1~a~/~e~ca,
<br />~/ ~ b
<br />~ r ~-q,,u%~~ ,
<br />,i-^~^~r -r-~.~ e~t,~w .~~ x,2.5 o-n = ~.x:P,/ ~~~d ~
<br />CERTI~!E!~ MAIL NO.T i_t~c~IZI I O~
<br />RE 11,x, . r`3cCEIPT REQUESTED
<br />iHa d. ~`~ d ~ S h.dw F,,,,,,,,;.r~ ~c ~., J~ r. e 6.
<br />I & E Contact Address
<br />NAME: TC~,1 ~+nh- n
<br />OPERATOR: ~~ „t^.,, ~-erP~n~~1 /`-~-,•-a ~ ~N-t~
<br />STREET: ~• ~ • ~~ fi ~7 L
<br />~ Ssb~57
<br />CITY/STATE/ZIP: ~ ,~.~,7
<br />~,,,~ ~"~
<br />~r~`y ~~
<br />136X Gq~c ~ ~6NS~
<br />K "',
<br />cc ^ CE
<br />^ BL
<br />^ FS
<br />^ HW
<br />^ HMWMD (CH)
<br />^ SE
<br />^ WQCD (CH)
<br />^ OTHER
<br />
|