Mineral Exploration Progress Report printable pdf download

Mineral Exploration Progress Report

FORM MR-EPR

(Revised December 27, 2011)

STATE OF UTAH, DEPARTMENT OF NATURAL RESOURCES, DIVISION OF OIL, GAS AND MINING

1594 WEST NORTH TEMPLE, STE 1210, BOX 145801, SALT LAKE CITY, UTAH 84114-5801

TELEPHONE: (801) 538-5291 FAX: (801) 359-3940

MINERAL EXPLORATION PROGRESS REPORT

PURSUANT TO THE TERMS OF SECTION 40-8-13(2) OF THE MINED LAND RECLAMATION ACT AND RULE R647-2-115, INFORMATION PROVIDED IN THIS REPORT SHALL BE

PROTECTED AS CONFIDENTIAL INFORMATION BY THE DIVISION.

DOGM EXPLORATION FILE # E/

PROJECT NAME:

NAME OF OPERATOR/PERMITTEE:

BRIEFLY DESCRIBE THE EXPLORATION WORK PERFORMED FOR DRILL HOLES, LISTED ON PAGE 2:

DESCRIBE UNUSUAL DRILLING CONDITIONS:

PROJECT DISTURBED ACRES:

BRIEFLY DESCRIBE THE RECLAMATION WORK PERFORMED:

IS ANY PORTION OF THE EXPLORATION PROJECT UNRECLAIMED?

IF YES, UNRECLAIMED ACREAGE:

BRIEFLY DESCRIBE REMAINING RECLAMATION WORK:

DATE OF COMPLETION FOR ALL RECLAMATION WORK, INCLUDING RESEEDING:

I HEREBY CERTIFY THAT (UNLESS OTHERWISE NOTED ABOVE), ALL DRILL HOLES HAVE BEEN PLUGGED AND ABANDONED IN COMPLIANCE WITH THE TERMS OF RULE

R647-2-108; THAT (UNLESS OTHERWISE NOTED ABOVE), RECLAMATION OF ALL DISTURBED LANDS HAS BEEN PERFORMED IN COMPLIANCE WITH THE TERMS OF RULE

R647-2-109; AND THAT THESE ACTIVITIES HAVE BEEN CONDUCTED AS OUTLINED IN THE NOTICE OF INTENTION TO COMMENCE EXPLORATION.

EXTENSION REQUEST

: I request this exploration notice be extended to the next exploration season for the following reasons (indicate anticipated length

of time required to complete exploration and reclamation):

NAME OF OPERATOR (TYPE OR PRINT)

SIGNATURE OF OPERATOR

ADDRESS/ CITY/ STATE OF OPERATOR

TITLE OF OPERATOR

CITY/STATE/ZIP

PHONE

DATE

FAX

Mineral Exploration Progress Report