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Drill Hole Completion Form <br />es <br />BLACK RANGE <br />A "I I',Fh A <br />Hole Number: 01,i 13Doco z <br />Completion Date: (pit., /21 1 <br />Total Depth: <br />Drilling Company: <br />Head Driller: Y , . i S <br />Instructed By Geologist To <br />Cement From (ft): 1- t ° <br />Total Plug Gel <br />Instructed: Z. S' <br />Actual Use: 2 <br />Total Cement <br />Instructed: 5lo <br />Actual Use: Lj <br />Geologist's Signature: <br />Head Driller Signature: <br />Cement To (ft): <br />t70 Its 19c- <br />(. )hr S <br />too Rr 6c <br />