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
Hole Number: 14
Completion Date: 0c-}- d 1•d.c v I 'li I )
Total Depth: •
Drilling Company: A s I)� C..
Head Driller:` „ S "I
Instructed By Geologist To
Cement From (ft):
Cement To (ft): 0
Total Pttrg Get
Instructed: 8 too NC
s
Actual Use: �i rg o Olf
Total Cement ® 2.s
Instructed:—.3-
l �3
Actual Use: 15 r 14,
y15
Geologist's Signature: 1..,___N-t__----,
Head Driller .A.,,,,,,W
2 ' 1 ' t (o 1 61 f- % 3 )& tokd t L k, L
1 rt fro , e The -. to
( 0 ' 13c-5 -0 S. - �f