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• ~ ~.1 (Page 2) <br />MINE ID # OR PROSPECTING//S~ID #_ q/ ! ~ ~Z - ~~0 <br />INSPECTION DATE (O - 30 ~/~ <br /> <br />INSPECTOR'S INITIALS_~Q~ <br />7`an2 ~~,` ~ 7~ Y,~uy~ ]` o ~ fie ~~ Cou-~ Cv~--,- i•-, ilsio~-~f/ <br />3e«ule/ .~ ~e;r- k~sj~7"<c ,~~/~~, 7`G~e `~'/•~~ f~./~.,s w/~ $~il<~r~s <br />[X-/•t' ~a ~e Yeti`-o~ u~oUY~- YLGI~".~//l"' •/T~-~ Wi~l~4~u1l ~<~ l f .// <br />(GtCIL~~~ ~~~ f"C p/J-.~py~,~/. ~i.~I is Q(/~'7/ [GY'!~ s~CGC SL ~~C~ w//'2 <br />a .~..p!!IV a ~ie~/ `~- O / <br />Ba1~,ty~ 1~ '~ O~.U ~~l/ w4/~ 6e,• re ~.,/. vr~ ~ 7li-e SCTe~ D <br />C~ / / ~-e /-~ r.,+ e p ~ L~.-e svn/~G/JTv~,- . ~~ v.iLf / ~ ~f ~~ Soyke' ~/v.. ~/ / <br />1-~~vve/~/-~i air-c~rTS YL~ar~ ~"~ ~~Jasl ~e ~.+r«f't u~ 7li.L t~..)F( <br />lao~c~' ~ih~ c(e<l..-~ ~~~/-poc~o~ cl~c~~S ~ ~o~a.7/~0~- <br />U~~1 ~ o~~~ e~>~~~/ `~---~ mfr p~ ~ ~ ~,~t~tl <br />y'Cv~a-i ~ 07^~ f /~/e . 1- ~•~f' vz ~ o h S~~ .A"^"~ ~ ~ u~G,~ G!~-~ r.~ i~ ads <br />l ri ~ w.; (( du, (d''~ Kr. J~~f~ >~•~ sa~~ 7~ er-~ /ti.~t be•~. ..~.,~- <br />eX~~OSwCJ <~- ~.e trf~ tiK~G / jlO. / <br />fir. Res eu-~.~f-~ ff~~ `~-~ ~-e ~.iKe l.~at ~.c ff 1,.~.~te~ 1~rre~~ <br />,~~w~ ~,cr ,~e~. ~~~ o~f~ `fp ~e w..in-e 7~.e ~ ~~~er w~ <br />~hs~~~ Q~e s~s7w~Q~- ~ ~ fie ,'s ~W~~ ~y s'~.-~-1~~ <br />~~~~~7j~/t/_v/'C/~m~^~- `f `'y~ > T ~,e ~d'y'.~ t~~ ( f~s~~~ '~~ f 17'v/CeJ <br />" 1 '"'.-Y !M. ! [met /ELI. / (~ e Ni/CF( <br />I & E Contact Address ec: ^ CE <br />^ BL <br />NAME ^ FS <br />^ HW <br />OPERATOR ^ HMWMD (CH) <br />^ SE <br />STREET ^ WQCD (CH) <br />^ OTHER <br />CITY/STATE/ZIP <br />