Flowing Hole Report for Geophysical Operations
Program Licensee:
License No.:
Program
Permittee:
Permit No.:
Approval
Number:
Water or
Gas:
Prospect Name:
Include shot point map for the relevant quarter section, indicating line(s) and shot point number(s)
m South
Location:
Section:
, Township:
,
.
Latitude & Longitude
NAD
m West
and
degrees
of the Northeast Corner of
Range:
,
.
minutes
W:
Meridian
.
seconds
degrees
.
minutes
seconds
Note: NAD Format Must Be Indicated
Date
Drilled:
Date Shot:
yyyy
Depth of
Hole:
mm
Charge Size:
yyyy
m
mm
kg
dd
Origin of Flow:
litres per minute
Estimated Flow Rate:
Date
Plugged:
dd
By:
yyyy
mm
dd
Specify how hole was plugged:
Remarks (e.g., bags of cement/bentonite, bladder and depth, pipe cut off below ground, successful or unsuccessful [flow
rate], etc.)
Contact Person:
Phone:
(
)
(please print)
Please complete in accordance with sections 46 and 47 of the Exploration Regulation (AR284/2006) and
forward to:
Alberta Energy Regulator
Twin Atria Bldg., 4th Floor
4999 – 98 Avenue
Edmonton, Alberta T6B 2X3
e-mailing this form to exploration@aer.ca
Alberta Energy Regulator Twin Atria Building, 4th Floor, 4999 – 98 Avenue, Edmonton, Alberta T6B 2X3
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