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<br />MINE ID # OR PROSPECTING ID #: FI _
<br />INSPECTION DATE 1/ f ~$ / `7 ~
<br />(PAGE 2) it- • •
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<br />I & E Contact Address
<br />NAME ~ 4~~-• Ci L"•l A; ^;
<br />CC:
<br />OPERATOR flA
<br />STREET ~k ~C=i
<br />CITY/STATE/ZIP WGODCriA~A Pt1KK~ L•[; S,';s,'~:(.,
<br />5149E
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