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(Page 2) ." `~. MINE ID # OR PROSPECTING ID #: ~ "-b 7 3 INSPECTION DATE: ~ ~t6~ OBSERVATIONS INSPECTOR'S INITIALS: ~a}-tPr-.~~e-p ~4 PA-R r r~L l~5pe<';; tam, ~i ~Efrs sr~~2 ~ s~ rr= 7`{~Q o t'e/2 a~~-e 2 [ZQ - AC5 t rlf~-T'eh a-F r ,ti r ~tTG /~ ~ r c~ Y 7Y e S 5 tom; C +z Ar ce~45z R~~ aeSCSr a~ZOprt w'~S fSSue,p c:~ Ju+~ ['Z~ L`F4=~j~ ruc~ s[r~ 4.~s+s t~rsa~~~a a~ du~E r7r~g~ ~-~-~Q,e '~. DaUrg[a~ 2~z-C-elUY.p q. ~rtl~L~roaT A-Bu-u~ ~4 Po5S[13Ze b LLe~ At D-t t ~tn36 L}-C Z't UL'7~ . 'T-43 e - 4J l V t. 5 t a .~ 1~~2~'~¢~2Kt.~! e ra ~"J-~-A-T TH-~z rt t A3/~u~ iF~.FY UL ~'t-j L}~'T' 9'FK 5 51 'I"'~ vJR- S ~ A~ SS fQ ~,2 1 LC_e.El}L. aP<a/y,~y~p~y ,¢Nt~ !S$LtQ~b A- C.esf3e R-ec.TTa lZ25c-Sr aRAsLr2. P~~ 5 iv~o~rt r-te.~ ~e~e. ape2.q-i eEZ . t/6a. a- ~2e.~.scu r~ ~2-~. I.~tle 1,Q7`re.,Q~ q'7f-q~ ,q. RoSi t /3 c.~. cr~a c.r~T~6N Q.Y - S2~S ~02 o-t,t~6~~ taSLZr'~ou~ A- fr2i2l`ttT', YFK-? ~lp2.Q.q-'~Q ~s~-s P.t?~u.l/t-raj i b ~.~T'eas D `F'G-62 J-t.E t~'Y .~~`~ l'g2g ~36s~2.r~ I-E~-I•~;(~ i'~ Re SPa+vIJ ~ "f-b~2. fyo53lr8LQ UGOt-at-~-Cnl.1, otis JuL4+ to ~-g'~l, `1`~e ~tJtSCCras R.eC.¢t V~eO A~c.J A~~~'rcc-us Gq-r.L 57741"T+J-G 9zfEF3' ~'~ (ir7' La~IQ-S STILL. F.~2L"Uto /-Ll~l3~e,p_/~QUSetAeR~ Ia 5 albSe2Ue.~ Dta, Q.t~T6 ~~5 i aSS PeC~'t c~Jt Tbde-2E, [ S /so ~' e A ea.C~ '~'~-'~a~'T'i[~e~e r~~~tJe ,ayes..., .~'~ Re.es~~r- ~vcrt~c7z~5 ~a-~ Y~FrS St~'e. (cto- (~-2e-S[st 77tA~c{~,g a-R f'2GSt~ 2X ¢A-+JA-'~Yc3el`5,~, 5~l-sae i S -.~ +-L r+v r-~}G ~4~' ~ t Prt~tT' 4'T' 7~1e S~[~. [ T' t~ve s ,~roT ~P/~2 `til-t--~' ~'a+e, ~~~t~ ~aA~~-tvc-r'~ us~9s R.e~-A-c~'itr,~.+.'r~D, I & E Contact Address NAME: ~~/'Rd.) MeL.,~ ~' OPERATOR: eLI?, j~ ~~}/~'~., P tJPPRZ,TIa S STREET: p . ~X '~~ J CITY/STATE/ZIP: ~p g' f h .~'~ CJ~-/BLS cr. ^ CE ^ BL ^ FS ^ HW ^ HMWMD (CH) ^ SE QCD (CH) ^ THER