Final Geophysical Program Information Cover Sheet
To be submitted within 90 days after completion
Prospect Name:
Geophysical File Number:
Rge:
Twp:
W:
M
Program Licensee Name:
License No:
Phone: (
)
Program Permittee Name:
Permit No:
Phone: (
)
Consultant/Company:
Contact:
Email:
Commencement Date (yy/mm/dd):
Phone: (
)
Fax: (
)
Completion Date (yy/mm/dd):
Primary Energy Source (Dynamite, Vibroseis, etc.):
Waterbody
Yes
No
Energy Source:
Program Type
Hard Copy Maps Sent to
3D LIS program
2D program
Intense 3D LIS
Land Use Officer:
Intermediate Intense 3D LIS
Forest Management Agreement (FMA):
Non-Intense 3D LIS
Municipal District:
Other:
Time Lapse
Clearing Type Information
Public Lands (only)
Total 3D LIS New Cut
Clearing Type Information
Source Receiver Combination
km
Total 3D LIS Existing Cut
km
Total 2D Cut
km
Total New Access
Total Seismic Lines on Private Land:
Forested Public Lands (only)
Overall Average
Width (m)
3D LIS Source
m
km
3D LIS Receiver
m
km
2D Combination
m
Total New Access
m
km
Total Seismic Lines on Road Allowance:
km
Map Requirements and Map Legend
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
Map scale 1:50,000 preferred; larger scale may be used for
large programs
Approval number
Program permittee & permit number
Prospect name
Energy source (explosive/non-explosive)
Section, Township, Range and Meridian (clearly identified)
Identify line types (source/receiver/combination/heliportable/survey line of sight, etc.)
Green / White Area Boundaries
Land ownership (public / private / federal land)
Parks and protected areas (provincial & wildland parks,
natural areas, etc.)
Zone 1 Areas
Surface hydrology (permanent - intermittent waterbodies /
rivers / creeks / etc.)
New cut / existing cut lines
MOF or CAFRA Blocks (Maintaining Our Forests/Canada
Alberta Forest Resource Agreements)
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
New cut / existing cut lines
Indian Reserves / Metis Settlements
Cities / towns / villages
Lines on surveyed road allowance
Immediate access (roads, trails, new / existing cut
lines)
Staging areas / campsites / heli-pads
Exploration Restricted Areas (ERA)
High pressure pipelines
Permanent sample plots (PSP) and industry
sample plots (ISP)
Endangered species habitat
Trumpeter Swan habitat
Key ungulate winter range (caribou, moose, deer,
& elk)
Forest Management Area
Municipalities and Special Areas
Comments:
November 2013
ED 2006-009
Alberta Energy Regulator Twin Atria Building, 4th Floor, 4999 – 98 Avenue, Edmonton, Alberta T6B 2X3
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