Notice of Intent for a Geophysical Program
The program licensee must send this notice to the Relevant Land Authority prior to
submitting their application to the Alberta Energy Regulator. This notice is to be included
with the submission for an exploration approval under section 23 of the Exploration
Regulation (AR281/2006),
To:
(Name of Relevant Land Authority: County, Municipal District, Special Areas Board,
Improvement District)
Attention:
Fax: (
)
(Name of municipal representative)
Please be advised that a seismic program is proposed in the area indicated below:
Program Licensee:
Proposed Project Name:
Location
Twp:
Rge:
W:
Twp:
Rge:
W:
Field operations will begin on or about the
20
(day) of
(month),
.
The energy source will be:
Dynamite,
Non-Explosive (e.g. vibroseis)
Other:
Field operations will be completed on or about the
20
.
(day) of
(month),
If you have any questions or concerns, please contact:
Representative:______________________________________
Company:___________________________________________
Phone: (
)
Acknowledged this
(day) of
(month), 20
.
_______________________________________________
(Signature of Municipal Representative)
Please sign and return a copy by fax to (
)
Attention:
Please Note:
November 2013
If this form is not signed and faxed back by a representative of the Relevant Land Authority, the
Alberta Energy Regulator will accept proof of delivery as confirmation that written notice has been
given to the Relevant Land Authority with respect to the Mines and Minerals Act (part 8) and the
Exploration Regulation (AR 284-2006).
ED 2006-06
Alberta Energy Regulator Twin Atria Building, 4th Floor, 4999 – 98 Avenue, Edmonton, Alberta T6B 2X3
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