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Drill Hole Completion Form <br />BLACK RANGE <br />Hole Number: oot <br />Completion Date: do 44 v Li 20 1) <br />Total Depth: 9 �' f <br />Drilling Company: "4 5 -t-L, 1)41 L) <br />Head Driller-Dj .. i <br />Instructed By Geologist To <br />Cement From (ft): J 9 <br />Cement To (ft): a <br />Total <br />Instructed: <br />Actual Use: <br />Total Gement <br />Instructed: <br />Actual Use: <br />Geologist's Signature: <br />Head Driller Signature: <br />