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If yon Have given a lease to others for all or part of the property, mate the names of the leasiag com- <br />panies, partnerships or individuals: <br />Name Manager P. O. Address <br />------------------------------ ------------------------------ ------------------------------ <br />L property worked continuouslyP___________________________________ <br />If work has been etopped,etnte when_________________________________ <br />Name, title and address of person in charge of work for you___________ <br />State the character of ore________________________________ <br />State the value of the ore_________________________________________ <br />MEN Eb1YLOYED <br />No. Employed No. Employed <br />____illnchine Drillmen, $______for____hourshift. _____Engineera, _ _ _ $______for____honrehift. <br />ninchine Helpers, $______for____hourehift. _____Pumpmen, _ _ $______for____hourshift. <br />_____Dlinera, _ _ _ $______for____hourshift. _____Firemen, _ _ e <br />_ $_______or____honrshift. <br />_____Timbermen, _ _ $______for____hourahift. Illnekamitha, _ _ $______for____hourshift. <br />----- <br />_____Trammera, _ _ _ $______for____hourehift. _____Tcamatere, _ _ $______for____honrehift. <br />_____Oro Sorters, _ _ $______for____hourehift. _____P'oremen, _ $______for____hourahift. <br />_____Topmcn, _ _ _ $______for____hourahift. _____Superinteadent, _ $______for____hourehift. <br />_____Laborera, _ _ _ $______for____hourahift. _____Oflice Help, _ $______for____honrshift. <br />_____Aesnyera, _ _ _ $______por____hourshift. _____>+fillmen, <br />_ _ _ $______for____hourehift. <br />_____Electriciana, _ _ $______for____hour-shift. Watchmen, _ $______for____hourahift. <br />----- - <br />---------------- - - $______for____hourehift. _ $______for____honrahift. <br />-- - <br />Average number of men employed this yenr_________ <br />-- ------ - ------------------- <br />----------- <br />a there n mi114_______________ <br />-------------- ---------------------------------------------- <br />Name of mill-----------------------------------Location of mill--------------------------------- <br />Charactcr of mill____________________________________ <br />------------------------------------------- <br />--------------------------------- <br />----------------------------------------------- <br />Cnpacity of mill_________________________________When was mill erected_________________________-- <br />Oivo list of buildings, tramways and other surface improvements _______ <br />--------------------------- <br />--------------------------------------------------------- <br />---------- ____ <br />Cost of aurface~improvements made in 191___ _ _ _ _ _ _ _ _ <br />State amount and chnrneter of underground development $ <br />' Tatnl Development Amount Done in 191 ~ <br />Shafts -----------------------------ft. <br />-------_____ft.; coat per Pt., $__________ <br />' Winzce ----------------------------ft. <br />--__________ft.; cost por ft., $_..________ <br />~ Drifts ------------------------- <br />____ft. ____________ft.• coat er ft. <br />P ~$---------- <br />Crosscuts --------------------------ft. <br />-___________ft.; coat per ft., $__________ <br />$ave you reported to this department all fatal sad non-fatal accidents ocenrring to workman in the <br />s twelve month precediag t date of this report, as required by law4 ___________________________ ____ <br />~ Rem ks:___~-~`--=~'-~=`~---~~'~ <br />--- ---- - ------ <br />- ~'/e~___~_~/----------------------------- <br />----------------------------------------------------- ----- --- <br />- - ------------------------ <br />Signed___L~1 - _" ~ <br />-------------- ~PW~~ <br />By---- f ------------- S -- . <br />------------------ <br />Title------------------------------------ <br />i <br />