Final Geophysical Program
Information Cover Sheet
To be submitted within 90 days after completion
Prospect Name:
Geophysical File Number:
Twp:
Rge:
W:
M
Program Licensee Name:
License Number:
Phone: (
)
Program Permittee Name:
Permit Number:
Phone: (
)
Consultant/Company:
Contact Person:
Phone:
Fax:
Commencement Date (yy/mm/dd):
Email:
Completion Date (yy/mm/dd):
Primary Energy Source (Dynamite, Vibroseis, etc.):
Waterbody
Yes
No Energy Source:
Program Type
3D LIS program
2D program
Hard Map Copies Sent to
Intense 3D LIS
Land Use Office:
Intermediate Intense 3D LIS
Forest Management Agreement (FMA):
Non-Intense 3D LIS
Municipal District:
Time Lapse
Other:
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.
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
Comments:
September 2009
ED2006-09
14. MOF or CAFRA Blocks (Maintaining Our
Forests/Canada Alberta Forest Resource
Agreements)
15. New cut / existing cut lines
16. Indian Reserves / Metis Settlements
17. Cities / towns / villages
18. Lines on surveyed road allowance
19. Immediate access (roads, trails, new / existing cut
lines)
20. Staging areas / campsites / heli-pads
21. Exploration Restricted Areas (ERA)
22. High pressure pipelines
23. Permanent sample plots (PSP) and industry
sample plots (ISP)
24. Endangered species habitat
25. Trumpeter Swan habitat
26. Key ungulate winter range (Caribou, Moose, Deer,
& Elk)
27. Forest Management Area
28. Municipalities and Special Areas