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~f ;ILL" '• ~i
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<br />It yon have given a lease to others for all or part of the property, state the names of the leasing com•
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<br />I ~'~ I ponies, partnerships or individuals:
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<br />~ Name --_--_-----binnager- --------_P: O. Address
<br />------------------------------ ---------- ----
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<br />ii ! ------------------------------ ------------------------------ ------------------------ .-.
<br />----------------------------- ----------------------------- ------------------------- --
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<br />Is property worked continuous]yi_ ~----------------- ------------------------------_--_--
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<br />i If work has been atopped,stnte tvhen---- -------------------------------------------
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<br />Name, title and address of person in charge of work for you__
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<br />I -----------------------------------------------~---- -- ----------------------------
<br />State the character of orc__~,,9~,,t.,`.p._y,r__~aw
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<br />-------------------
<br />-------
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<br />i ' State the value of the orc:~A4l~S~ 3l_____________
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<br />! I 11fEN E)1fYL0YED
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<br />I No.Employcd ~~ i~To.Employed
<br />~: .~L_llfnchine Drillmen, $_~ ~forR~ _hourshift. _a-Engineers, _ _ _ $__~}__for ~_hourahift.
<br />" ' ~ ~ -__lllnchinc IIcl ere $______for____hour shift. _____Pum men, _
<br />--- P P _ $--____for_~;.hourshift
<br />
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<br />~-9_.liiners, _ _ _ $_ 3___for_:4__hourshift. _<'3....Firemen, _ _ _ $__s}__!or_~_hoursbift
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<br />_1~_Timbermea, _ _ $_3..-_far_$_hourshitt. _____f3lncl:amithe, _ _ $______for____hourshift.
<br />i; j aQ_Trnmmera, _ _ _ $__3__for__Y._hourahift. _____Tenmaters, _ _ _ $______far____hourabift.
<br />'
<br />J Ore Sorters,
<br />----- _ _ $______for____honrshift. _..~_-Foremen, _ _ _ $_-!~__for_g_honrshift.
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<br />----- _ $______for____hourahift. __I__Su erintendeat
<br />Topmen, _ _ p _ $_ `,___far_-__hourshift.
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<br />~ __--=Laborers, _ _ _ $______for____hourahift. _____ORlcc IIelp, _ _ $______for____hourshift.
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<br />I~ ; ~ ~esaycrs, _ _ _ $______for____hourahitt. _____lfillmen, _ _ $______for____hourshift.
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<br />' _____Electricinns, _ _ $______for____hour-shift. ..____R'atchmea, _ _ $______for____hourshift.
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<br />~ j ---------------- - - $______for____hourshift• ______ _ $______for____hourshift.
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<br />' Average number of men employed this ycnr_4k~_______________________
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<br />' __.___
<br />Ia there a mi1lY_-----~------__--.-
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<br />Name of mi]1---------~~------------------------Location of mill------------------------
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<br />; ,I~ I~ --------
<br />Character of mill------'1--------------------------------
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<br />~ Capacity of ~uill---------'1----------------------When was mill erected----------
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<br />Oive list of buildings, tramwnye and other surfnee improvements _________
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<br />Cast of surface improvements made in 191w_ _ _
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<br />:i - - - - - $---r
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<br />State amount and ehnrneter of underground development:
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<br />,i I Total Development Amount Doae in 197a'~
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<br />~ Shafts --------~`1-Q-------------ft. ----~° Q--ft.; coat per ft.
<br />ffi----------
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<br />inzes ----------- -- -----------
<br />- _ft. ___ft.; coat per ft.
<br />$°--____--
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<br />Drifts --------`~A.°-A----------.ft. ----L?-AS~
<br />_ft.; coat per ft.
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<br />$
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<br />_____
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<br />tiT088ente ________~II.tj____________ft. ~_
<br />ft
<br />; coat
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<br />ft
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<br />., $__________
<br />~-~.~-•-..9. 5
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<br />$ave you reported to this department all fatal and so
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<br />a
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<br />accidents ocenrting to workmea in the
<br />twelve months precediag the date of thi
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<br />~ ;' s report, as required by 1nwT ___ ~1-~e~_
<br />Iiemarke:-----------------------------
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<br />~' 'I 4! I Signed_ 1~~.R .
<br />~`~`'~A~L1X~~2Company.
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<br />Title----------
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