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/' IPage 2)
<br />MINE. "ID # OR PROSPECTING ID # I'"1 ^77- O ~
<br />INSPECTION DATE /~~~}-g (p
<br />
<br />INSPECTOR'S INITIALS .J
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<br />i ~ E Contact Addre
<br />NAME To ~ ~ STO~7CI,ce t3RA~ A
<br />OPHRATOR f-~-SP~AL1~1 COI~15.7R,f-tC,Tnt~S. / ~.
<br />STRHHT ~7Ga~b I7-VJY I6~iA)t P. `V. oc7X '~-Q
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