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

1
Drill Hole Completion Form
BLACK RANGE
^o.NE , A1
Hole Number: I'NNE
Completion Date: p+ l ?1„0 l 1
Total Depth: o 10 1
Drilling Company:
Head Driller: `',,, f .. / I Stivtlt.
Instructed By Geologist To
Cement From (ft): 1.0(09,S
v.+
Total Ptug l-
Cement To (ft): 0
(1 9 \ Actual Use: 3e, ( 1 by I
Total Gement ---
Instructed: S )
Actual Use: 5p 0
Geologist's Signature: ee
Head Driller Signature:
Instructed:
)1.4,44(
C y-vt v t ' V 5v-4 k2 , I l�^✓ a 3'1 ',
,mo d 5 .,,o µ k ,,,, � r mil' - 81 If R , 11 b)
0-3 'E° to' lalo st.-f GP (0,4 cv-e4 4o 11.- fr d