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
sib
BLACK RANGE
MINt HALS
Hole Number: t-IN6- ?
Completion Date:`) Zs - z.o u
Total Depth: 9sq, b
Drilling Company:`Dg5 4. `; I L,
Head DrillerT ,,
Instructed By Geologist To
Cement From (ft): c7.3q
Cement To (ft): o
Total Plug Gel
Instructed: 12 CI -11)f h`,./
Actual Use: 171 5v _/ 6j k11
Total Cement
Instructed: Liz f ao - )19s b�
Actual Use: 1x /i L
Geologist's Signature:
Head Driller Signature:
- S.) z. 44 0 ; 1 I bf t ki • S /L 6 -e4t-A
109 - d -� = 3:' - + 0 100 1 1, i - (4- t b) 6,43,,.;1--c