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<br /> MINE ID # OR PROSPECTING ID # A4 22-3?g
<br /> INSPECTION DATE 117 /�S� INSPECTOR'S INITIALS Tj
<br /> OBSERVATIONS
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<br /> I & E Contact Address cc: ❑ CE
<br /> ❑ BL CL
<br /> NAME LaNI•%., /Der7ho ❑ FS
<br /> OPERATOR ->f.!dm-j/s,--q1' ���" y�YF' . ❑❑ S
<br /> / HMWMD (CH)
<br /> STREET l�_ Lq_ /30 x 07 A[ WQCD (CH) �f�oiJ �6iGrY1p r �r So,; �
<br /> CITY/STATE/ZIP S r Zi1er-/Ovj , 6 0 91�4 3 j 0 OTHER /�,_��r' �0f?Z)Z22-1 S�i�
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