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I " <br />_' • <br />AGE 2> <br />MINE ID N OR PROSPECTING ID tt: ~ - ~ ~- / .3 ~ - _ _ <br />INSPECTION DATE _ G /~ _~/~ Z INSPECTOR'S INITIALS~C S <br />OBSERVATIONS <br />~'~ S~ f~ rrr/Cc S ~ ~i «s a c ~~ vP~ r,~ ~ rt ~Gz/ Q 2" <br />~~~ ~~ z° v-~' ~ P ~ns~ ~'c C /lr~~ ~ crvSLc e~ <br />Gras vP~~~il~i~~ ,~ a ~~~~ ~-~ ~~.~ <br />!~ Y z -P ,~6 H Z - ~vrG1 /~G GC PAS ,.~/ v ~ /~ i,-rs Q /~ ~ K wGc /~ <br />ZU ~~P P~s~ D-~l C ~P ~rDCPss/roc ~ .~//'` <br />/ S <br />S / ~t° (~ S P~ ` C~ ~~°!~ O v ~' G v Pr ~ U ~rG~Pn l 12 L° <br />~ rGti Z Gi .r ~ C~ ~ ~° - sai <br />~y ~ ~ G L2 I~Gc C< ~j Lp~K SCc /i/GC~ P~, <br />/~Ltf~ct(t° ~/~~~ QviG~ ~LCE' CtCz1i~,P Q~P~, <br />,~ <br />~ ~~ ~ ~ S!'vtCc~~ ~~~L'c°/~ Z~Gc~ ~° ~~ ~~P 7ZdZC~ <br />~~ r~ / t ~ ~~Gc <br />/~10 ~rvhle~S x~ztCd Cllvr/~~ ~~,s /d,5~~~z<~~~ <br />I & E Contact Addressyy~~// C <br />NAME ~!:'~~ /~~U'~'f~S _ CC: ~/!~ S~~vPl~CS <br />OPERATOR~~ /~(UYC ~S ~G'yr 5 I ~'/iC ~~d~ r~G~ <br />STREET C~ ~~i~~D''X ~~,~,/S ~/% <br />CITY/STATElZIP ~C~l~rCcf~C' ~~riYrS-S C~ <br />~ T- <br />5149f ~Cl~~~ ~57~ I <br />