|
(Page 2)
<br />MINE ZD "# OR PROSPECTINNG ID p ~(-7Q~-] ~
<br />INSPECTION DATE p z~ 14 (j
<br />-~-~
<br />~SERVATIDNS
<br />t~az . KceisL~~ ~tQe,~, Max I ~i ,
<br />~~, ~~,
<br />
<br />INSPECTOR'S INITIALS JC-~i
<br />,,
<br />~n,rh ~~~ .,_ 0 ~ ~
<br />Mt( (xL:e[~t (~P~~1~1J~D8' ~ ~
<br />~'Y~vrumtnri~ ~~~ I?~o lPl~~o Gem ~~ c~c ~ 4P~ l~G.u~.Q ,
<br />~'6i~Ccu~c~ ~e nn~rt -~+~ U.~d -lzc~ra~ ~~ &n ~ ~~ ,u.~t~.~ (~ '
<br />~, ~ .. ,
<br />maF,wvw~c~, Tlu;, lD~it,1k,Q D~uaa+~, anQ"Q ,~ ~ ~ ~a~ ~ v~M
<br />~.,~r-~+.).~fG~ ~~ e-ellru~7~ ~vwr~w~ Op.~,~ ~c ~e cuna~f~r.~u,~i,
<br />I~o~, ~na~.unrrpan ~1~ ~~ct-7~ ~ti+~u~ ~, ~~, r~~~n.~~ ~ a awe
<br />[~D~a~sc. ~,ciee ~ caw~ir ~~~~~~ ~ e~ Cie ~ ~ ~ ~e, e~
<br />~u~nu~ ~~,,,~,~,~, ~~u~c~ ~"uaaaD~, Lu, ~~c~-;ue ccrin~~
<br />t~i~rnu~¢t~ ~~iU,~y 9~ ~CP~~ ,~cr;~ j 13, 5(6) D~@. [~ I ~ ,~~,
<br />~b{t~ ~~~~~ ~~s~~ ~~ u+c~ec~nl~oi~~{~~ G~ o~ u~~e~.
<br />(~. ~Gueuk-[G~ ~~ ~ m~t~,n~.P~,u~ uae " E~.~ci-aG~ 1t~2~~
<br />2~~i~j ~~ ~~ ~; ~ ~~ ~ ~ ~~ ~eP~rn ~r~e ~rn~~
<br />'~ ~ '~' ~ s'~, ~sQ~ ~ curo~Q cP~P~v~ ~.uo~i~Geara~~~ans~.
<br />I ~ E CO td r n.iA
<br />0
<br />NAME KQ. A.IARSNA-[~ Rr~rr z2 cam: o ei
<br />OPERATOR ~-u~ o ,~,,
<br />! ~1'~(D~T CDUu1'y DST DF~'L.Aa,u) ~ ~ ~ Fs
<br />STRfi&T _~~~ r,~1,~lttq~Q~J//iv(~_ K/I~7~~j 0 S~~ (CH)
<br />CITY/STATE/ZZP ~/IrvD~ L" ~~ ~(/ ~~z(2 O WAD (CH)
<br />n ~/~ ~? ~~ / /' ~} 7' Y O OTHER
<br />1. Tlf'`'~ Y~'lQ~..L- 7_ L~IW"7`/c~-.SlS~J
<br />
|