2012-10-12_REPORT - P2009025

• Permit No: P2009025
• IBM Index Class Name: REPORT
• Doc Date: 10/12/2012
• Doc Name: ANNUAL FEE/REPORT
• From: BLACK RANGE MINERALS
• To: DRMS
• Email Name: TC1
• Media Type: D
• Archive: No

Drill Hole Completion Form
BLACK RANGE
F H n
Hole Number: c 5
Completion Date: 8/' 1,11
Total Depth: ()Cc);
Drilling Company:D'} 1)v./
Head Driller c- h, w 1 \ c
Instructed By Geologist To
Cement From (ft): to (a 6
Geologist's Signature:
Head Driller Signature:
Cement To (ft): 0
Total Plug Gel
Instructed: c l , S
Actual Use: 1,5 l hs hti
Total Cement
Instructed: 7C /;. i hr /
Actual Use: 2 C I 1,,
lob g 5 '-1 `t u I# 0, b) tor-14k (t - u 0 0 3c 1 b
550 - o : L b,A. ks Vw? :-F- - ► �.. = h o , 1 #70 3 b j)
e -4(4 d ��► �� ii4u r gs) , �, � ,1 1-5 11,1 ,f b � �