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If yon have given n ]ease to others for till or part of tho property, state the names of the ]easing oom- <br />paniea, partnerships or individuals: <br />711anager P. O. Address <br />Name <br />Ia proPertp tivorked continuouslyf_________ ~ ---------------------- <br />- -- - - ------ <br />If work has been stopped,stnte wben-------------------------------- ~ ~,~ <br />L ~ ------ ---.-- --------- <br />Name, title and address of persoa in charge of work for you___ [-_-~°~'--- ---- + <br />--- <br />State the chnrnetcr of ore________ __ <br />State tha value of the ore__ ~~ _4°C~9_--~'-'6-t-'-k'-~~- <br />MEN EMPLOYED <br />No. Employed <br />~___bSnchine Drillmen, $______for____hourehift. <br />_____bfachine SIelpcre, $______for____hourshift. <br />i1[iners, _ <br />_ _ _ _ _Timbermen, <br />____ 'Prammers, _ <br />_____Orc Sorters, <br />_____Topmen, _ <br />_____Lnborers, _ <br />_____Aseayera, _ <br />_____Electricians, <br />---------------- <br />_ $_d~°_for_~_hourehift. <br />_ $______for____hoursbift. <br />_ $______for____hourshift. <br />_ $______for____hourshift. <br />_ $______for____ttoursltift. <br />_ $______for____hourshift. <br />_ $______for____hourehift. <br />_ $______for____hour-shift. <br />_ $______for____ltourshift. <br />.. ~. ,...Y..,, ~.. <br />_____Engincers, _ _ <br />_____Pumpmen, _ <br />_____Firemen, _ _ <br />_____Tilsckemiths, _ <br />_____Tenmatera, _ _ <br />_____Foremen, _ _ <br />_____Superintendcnt, <br />_____Ofl'ice help, _ <br />_____Alillmen, _ _ <br />_____wntchmen, _ <br />---------------- - <br />$______for____hourahift. <br />$______for____honrehift. <br />$________°or____hourahift. <br />$______for____hourshift. <br />$______for____ltour shift. <br />$______for____Itonrshift. <br />$______for____honrahift. <br />$______for____hourshift. <br />$______for____hourahift. <br />$______for____hourshift. <br />$______for____hourshift, <br />dvernge number of men employed thin year_______!_______________________----------------------- <br />Is there n mi114---------~ U ---------------------------------------------------------------- <br />Namc of mil1--'--------------------------------Location of mill--------------------------------- <br />Charneter of mill------------------------------------------------------------------------------- <br />Capacity of mill_________________________________wben was mill erected__________ <br />Cive list oP buildings, trnm~vnya and other surface improvements _________________ <br />Coat of surfaco improvements mode in 191_d_ ~C~~Cr'~-~-_ _ _ _ _ _ $_____ <br />State amount and cltnracter of underground development: <br />Total Development <br />Shnfta --__~f_P--------------------ft. <br />winzes ---1 z~-------------------ft. <br />Drtfts __________!L________ ___~_ft. <br />Crosscuts ____ J:~'_ ~!_'-°"rft. <br />dmount Done in 191$1 <br />___________ft.; coat per ft., $__________ <br />ft.; coat per ft., $__________ <br />___-.f_o-tt___ft.; coat per ft., $ r~z =:~ __ <br />______<_l:°___ft.; cost per ft., $__ ~L:'~ _ <br />/9~Y <br /> <br />$ave you reported to this department all fatal sad non-fatal accidents oeenrring to workmen in the <br />twelve months procediag the d~.to of this report, an required by lawf __~~'_~._p?~!'2*_~ ____________ <br />Remarka:_r'_~_ 1?~.~~~.-~~ °'~C/' ~ Ge~i~t Lrs.ele .+. °( Ge-+~+.1~`,,,,~~/ <br />---~ -- ---~----'-------~`-'t-'---------------dam __--- <br />--------- ---- <br />------------------------------------------------- -------- <br />,4e.,,lt 6 o ct ----------- --------- --------------- <br />-------- --------------`-`~----- E`-`-~ ---Ja_`.~~- ~` .2 L...-~.~. <br />----------------------------------------- <br />Signed---GLNC?sa_S~?Ls-YCw _CO-~-l-~---Company. <br />By-----~---`-`-'-[-~~sj~--qQ -~-'----+----------- <br />