PA 22A Notiec of completion of seismic survey or scientific survey

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PA 22A Notiec of completion of seismic survey or scientific survey Powered By Docstoc
					                                                                                                        Permit No.
                                                                                                                (Office use only)


                                                                                                                      Mines ABN 24 830 236 406



        Notice of completion of seismic survey or scientific or technical survey
Petroleum and Gas (Production and Safety) Regulation 2004 Petroleum Regulation 2004 Geothermal Energy Regulation 2012
                                         Form Number PA-22A Version Number 4

                                    Further information and copies of forms can be obtained from the Department of Natural Resource and Mines or
GUIDE FOR APPLICANTS                from the internet: www.mines.industry.qld.gov.au.
                                    Note: Pursuant to section 813 of the Petroleum and Gas (Production and Safety) Act 2004 and section 332 of the
                                    Geothermal Energy Act 2010, a document containing information that is false or misleading may attract a
                                    maximum penalty of 500 penalty units.
The original of this should         Please print clearly in ink and use block letters. If there is insufficient space, use attachments.
be forwarded to the                 1. Indicate the type and number of the permit the survey was conducted within
Department within 10                       or, for a data acquisition authority, the petroleum tenure to which the data
business days after the                    acquisition authority relates:
completion date of the
survey. A copy of this               1.0      Tenure type:
notice must be served on
each landowner and
occupier at least 10                 1.1      Tenure number:
business days after the
completion date of the
survey.                                       Principal holder
                                     1.2
                                              name:
Question 1
For a data acquisition authority,
detail the petroleum tenure type
                                    2.      Survey details:
and number to which the data
                                              Type of survey:
acquisition authority relates.       2.1                                 seismic survey

Question 1.2
Indicate the name and details of
the principal holder, in whose                If seismic survey 2D or
                                     2.2
petroleum authority the survey                3D:
was conducted. Indicate the
name of the operator,
previously nominated by the          2.3      Operator name:
principal holder of the petroleum
authority in which the survey
was conducted.
                                              Identifying name or
                                     2.4
                                              code for the survey:
Question 2.1
For example, seismic,
geophysical, geochemical,
geotechnical, ariel etc.                      Actual date of
                                     2.5
                                              commencement:
Question 2.4
A survey is completed as soon
as all the raw data for the                   Line Spacing
                                     2.6
survey has been recorded or                   (magnetics)
recovered.

                                              Station density
                                     2.7
                                              (gravity):



                                               Area (km sq) or line km
                                     2.8
                                               (where applicable)

                                               Energy Source
                                     2.9
                                               (where applicable):


                                               Magnetometer (where
                                     2.10      applicable):



                                               Gravity Meter (where
                                     2.11
                                               applicable):
                                                                           2



GUIDE FOR APPLICANTS                    3. Local tenure contact details
                                        3.1 Provide the contact name and details of the tenure holder or an authorised
Question 3.
                                        person who may be contacted to discuss any matters stated in this notice.
Enter the name, address and             Full name
contact details for the
authorised person who is the
contact in respect to the notice.
                                        Company
The contact person may be
either a holder of the tenure or a
person authorised to act on
behalf of the holder.
                                        Address
The nominated contact person
will be required to discuss any
matters stated in the notice if
contacted by the landowner and
occupier of the land subject to
the notice.                              Suburb
Notes for landowner and
occupier:                                State                                                   Post code
If you have any questions
relating to the contents of this
notice, please contact the               Phone number                                            Fax number
person listed in Question 3.
                                         Mobile number


                                         Email address



                                        4. Signature of holder or authorised person:
                                              By signing you confirm that the relevant sections of the Petroleum and Gas (Production and Safety) Act
                                              2004, Petroleum Act 1923 and the Geothermal Energy Act 2010 and their associated regulations will be
                                              complied with, and that the information contained within this notification is true to the best of my
                                              knowledge.
                                          Attachment A Map                                                                                    Tick
Question 4.
The signature of a relevant                 This map must clearly show:
technically competent officer is
                                                 Location of the area to be surveyed
required.
                                                 Any existing permits
Note: To submit forms                            Location of any other known wells, water bores, previous surveys and
electronically, email                             public utilities.
dmepetroleumtenures@dme.qld               Attachment B Performa
.gov.au

Additional Requirements                 Additional requirements
A copy of this notice must be           A copy of this notice must be served on each landowner and occupier of the land 10 business day
provided to each landowner and          before you enter to undertake activities.
occupier. Tick the box to verify
that this requirement has been                                                                                                              Tick
met.                                         I acknowledge that a copy of this notice will be served on each landowner and
                                              occupier of the land 10 business days before entry.




Disclaimer
The Queensland Government Department is collecting information provided on this form for the purposes of assessing the suitability of your notice of
completion of seismic survey or scientific or technical survey and maintain the public searchable register under the Petroleum and Gas (Production and
Safety) Act 2004 (‘P&G Act’), Petroleum and Gas (Production and Safety) Regulation (P&G Reg’), Petroleum Act 1923 (‘PA1923’) and Petroleum
Regulations 2004 (‘the Reg’), the Geothermal Energy Act 2010 (GEA) and the Geothermal Energy Regulation 2012 (GEA Reg). This information is
authorised by sections 34 of the P&G Reg and 565 of the P&G Act, section 19 of the Reg and 80B of the PA1923, section 273 of the GEA and section 11
of the GEA Reg. Some or all of this information may be provided to other agencies of the Queensland Government for the issuing of an environmental
authority, to make register searches, extracts or copies under section 566 of the P&G Act, 80CA of the PA1923 and 275 of the GEA. Your personal
information will not otherwise be disclosed to any other third party without your consent, unless authorised or required by law.

				
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