£ minisvyoj report - ontario
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£ MinisVyoJ ReportNaloral Of Work Resources
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Address of Recorded Holder 52F15NES884 W8481-88I47 BROWNRIDGE010
Summary of Work Performance and Distribution of CreditsTotal Work Days Cr. claimed
for Performance of the following work. (Check one only)
Q Manual Work
[~Jshaft Sinking Drifting or other Lateral Work.
(^Compressed Air, other Power driven or mechanical equip.
(2 Power Stripping
[^Diamond or other Core drilling
0Land Survey
Mining ClaimPrefix Number
Work Days Cr.
/ r
Mining Claim*Prefix Number
/
'••F-\! - 'V^i.";im<
Work Days Cr.
S-f
Mining ClaimPrefix Number
Work Days Cr.
All the work was performed on Mining Claim(s): 4-j, C
Required Information eg: type of equipment, Names, Addresses, etc. (See Table Below)
Nff GEOLOGICAL ASSESSMENT FiLP
SEP 2 \ 1984Date of Report Recorded Holder o^Agent (Signature)
Certification Verifying Report c WorkI hereby certify that I have a per; or witnessed same during and/or i
al anpjinftt fhe facter its
Name and Postal Address of Person Certifying
set forth in the Report of Work annexed hereto, having performed the work rt Is true.
Date tified Cer
Table of Information/Attachments Required by the Mining Recorder
Type of Work
Manual Work
Shaft Sinking, Drifting or other Lateral Work
Compressed air, other power driven or mechanical equip.
Power Stripping
Diamond or other core drilling
Land Survey
Specific information per type
Nil
Type of equipment
Type of equipment and amount expended. Note: Proof of actual cost must be lubmitted within 30 days of recording.
Signed core log showing; footage, diameter of core, number and angles of holes.
Name and address of Ontario land surveyer.
Other Information (Common to 2 or more types)
Names and addresses of men who performed manual work /operated equipment, together with dates and hours of employment.
HW 1*0Names and addresses of owner or operator together with dates when drilling/strippingdone.
' Nil
Attachment
/
Work Sketch: these are required to show the location and extent of work In relation to the nearest claim post.
Work Sketch (as above) In duplicate
Nil
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Report of Work(Geophysical, Geological, Geochemical and Expenditures)
The Mining Act
Instructions: — Please type or print, f ' I 3 "*l— I f number of mining claims traversed
exceeds space on this form, attach a list.Note: — Only days credits calculated in the
"Expenditures" section may be enteredin the "Expend. Days Cr." columns.
- Do not use (haded areas below.Type of Survey(s)
fllffrfiC*/ f£* 77 («Claim Holder(t)
Township or Area
6 tf t /v/ /7c/? g , •-7Prospector's Licence No.
7~ //*•' t >Address
' Company Date of Survey (from & to) Total Miles of line Cut
Name and Address of Author (ol Geo Technical report)
Credits Requested per Each Claim in Columns at rightSpecial Provisions
For first survey:
Enter 40 days. (This includes line cutting)
For each additional survey: using the same grid:
Enter 20 days (for each)
Man Days
Complete reverse side and enter total(s) here
Airborne Credits
Note: Special provisions credits do not apply to Airborne Surveys.
Geophysical
• Electromagnetic
- Magnetometer
- Radiometric
- Other
Geoloaical
Geochemical
Geophysical
- Electromagnetic
- Magnetometer
- Radiometric
- Other
Geological
Geochemical
Electromagnetic
Magnetometer
Radiometfic
Days per Claim
Days per Claim
______
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Days per Claim
Expenditures (excludes power stripping)Type of Work Performed
Performed on ClaimU)
Calculation of Expenditure Days Credits
Total ExpendituresTotal
Days Credits
$ /, i
InstructionsTotal Days Credits may be apportioned at the claim holder's choice. Enter number of days credits per claim selected in columns at right.
Date Recorded Holder or Aflent (Signature)
Certification Verifying Report of Work
Mining Claims Traversed (List in numerical sequence)Mining Claim
Prefix Number
ON1 ARIO GEOLOGICA
O
SEP 1 91
E C E 1 V
Expend. Days Cr.
Mining ClaimPrefix Number
Expend. Days Cr.
Total number of mining claims covered by this report of work.
1 hereby certify that I have a personal and intimate knowledge of the facts set forth in the Report of Work annexed hereto, having performed the work or witnessed same during and/or after its completion and the annexed report is true.
Name and Postal Address of Person Certifying
Date Certifi
1362 (81/9)
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