This form is to be filled out by any company proposing to conduct seismic activities in Zone 1.
1. Yes No Do you hold any mineral leases (either wholly or partly) in proximity to Zone 1?
If YES , please include a sketch of your holdings in the area.
2. Yes No Does your company (or any of your partners on this program) own any producing wells in Zone 1 or in close proximity to Zone 1?
If YES , please identify these wells, and the year they were drilled.
3. Yes No Are there other producing wells in the area (in or around Zone 1) not owned either by your company or any of your partners on this program? If YES , please identify these wells.
4. Level of Operations Being Applied For In Zone 1:
Yes No Do you propose to hand-string geophones only, in Zone 1?
Yes No Do you propose to drill shot points in Zone 1?
If YES , what shot point spacing will you use?
5. What is the anticipated commencement date and completion date for the Zone 1 portion only? commencement date completion date
6. Yes No Do you propose to use heliportable recording techniques?
7. Yes No Have you carried out an on-site inspection of the area?
8. Yes No If you have inspected the area, do you anticipate having to do any clearing of vegetation. If YES , please indicate an approximate distance of hand clearing that will be required.
9. Additional comments (if required)
GEO 23 (11/2013)
Alberta Energy Regulator Twin Atria Building, 4th Floor, 4999 – 98 Avenue, Edmonton, Alberta T6B 2X3 Page 1 of 1