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' (,Flags 2) ~ ~ 3
<br />MINE ID # OR PROSPECTING InnD # ~`~O- U'Yy-
<br />INSPECTION DATE ~ Q - Qj ^'1. ~ INSPECTOR'S INITIALS~~y
<br />~ OBSERVATIONS
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<br />i & E Contact Address cc: ^ BL ~~~ ~ ~'~ 1
<br />NAME ^ FS
<br />^ HW
<br />OPERATOR ^ HMWMD (CH)
<br />^ SE
<br />STREET ^ WQCD (CH)
<br />^ OTHER
<br />CITY/STATE/ZIP
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