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1G`7 <br />Natne of Ttine _-----_-~~`~~"v----!~~!__-- <br />Date of <br />Location <br />Blinin District ____~ l~"Ub~__ '_ ~~~K- <br />g ~Q - -----------' <br />County of______LX__ /~~.,ti_______State of Colorado. <br />Principal Office Located at____________ ~ "-r ~=`v~ 1 <br />~~ ~~ 77------ <br />Branch Office at________________ ~Jti'!~%S!?___ ~-~-5 <br />---- _ <br />Vame and Address O&cers________/____ =J_/~t!_ ~?~ <br />.r ---`~- <br />~_____________LL_ <br />A]ticude at ruin Workings-----____1"'JTi-~D -------------------------------°------------ <br />Charac[er of Country Rock ________________ ~~<-<=~•~ <br />U- ------- ------°--------------------------°-- <br />Character of Veia---°-------------------~'(~~~jjj`~ 'LU=r'`~--------------------------.._----- <br />Character of Walls or Enc]osing Rocks _________,t-r =!r~__-e!~!~ _____________________________ <br />r ~- ~- <br />Character of Ore______9/__G!!~___ __~~r'~ ~~~~_f.':!2_'~-.-- ~u'-'`~`~=---- <br />_ _ <br />pre Occurrence------------ --~ ---°•---------°------------° .._----°------°°-- <br />1)eeelo evt, Ventilation, Sanitary Co/edition, Exits .____ __ ___-~~~___'_! ~~r'--~~`_/k~:'/~- <br />-__ <br />``~-/---~i~rt_Le----~1-!rv!Z.=~"---ILG--`-``-"~-~,e ~,~j~~e:__PGu~.'.t~ <br />--- °•-------°------------------•---•--•°------•----•---••-•-----r,-------°----------•° <br />