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<br />(Page 2C) <br />MINE ID # OR PROSPECTI <br />NG ID # i''7 9i-o 97 <br />INSPECTION p <br />p <br />DATE _ ~ / 7-7 ~i s-/a-9~f <br /> <br />INSPECTOR'S INITIALS ~J~',~ <br />~-era- ~~s<4~Y,c~) ~ .~ ~.,~. Go o~~ ('/ ~~- CJ <br /> <br />~~~~~ <br />~. <br />• /~G~-~2 ~.e `t5^~~7~/'L_ /Qp ~~ 9G~b'o,y/~~° ~ ~ ,.CtQ,G ~°-~~~,w-~..~-v-e ~ i <br />~~Y'~K ~~J~"u-t~"w ~/~(,cIL Lfv'J'CaGtJI'l •~~~C/~ ~A~ ~~ <br />.~C".v~eC,Cc~~ c~0a~~.~trr .AR4oQ~,,li~j' ~.~~~~,~1~/ ~ /S'9~ .ti.rW`< .5~ /~' <~~~~ <br />I ~ E Contact Address <br />NAME <br />OPERATOR <br />STREET <br />CITY/STATE/ZIP <br />cc: ^ CE <br />^ BL <br />^ FS <br />^ HW <br />^ HMWMD (CH) <br />^ SE <br />^ WQCD (CH) <br />^ OTHER <br />~~ ~:~~~ 4 <br />6~~~ <br />/ <br />