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									          www.dme.qld.gov.au   ABN 98 628 485 885




  NOTICE OF COMPLETION OF SEISMIC SURVEY
    OR SCIENTIFIC OR TECHNICAL SURVEY
                           Petroleum and Gas (Production and Safety) Regulation 2004 – Section 34
                                          Petroleum Regulation 2004 – Section 19
                                          Form Number PA-22A Version Number 2



                                        THE ORIGINAL OF THIS SHOULD BE FORWARDED TO THE DEPARTMENT NO
 OFFICIAL USE ONLY                      LESS THAN 10 BUSINESS DAYS AFTER THE COMPLETION DATE OF THE SURVEY.
           PART A
                                        Please print clearly in ink and use block letters. If there is insufficient space, use
Received AT     Received BY
  (Office)       (Signature)
                                        attachments.


                                        1.          Indicate the type and number of the petroleum authority the survey
       DATE        OR DATE OF                       was conducted within or, for a data acquisition authority, the
                    RECEIPT
                     STAMP                          petroleum tenure to which the data acquisition authority relates:
   /     /


GUIDELINES                                    Tick One       Tenure Type                             Number(s)


Question 1
* For a data acquisition
authority, detail the petroleum                                Authority to
tenure type and number to
                                                             Prospect (ATP)
which the data acquisition
authority relates.


                                                            Petroleum Lease
                                                                  (PL)




                                                            Data Acquisition       Related Petroleum                 Number
                                                            Authority (DAA) *        Tenure Type
                                                                 2
GUIDELINES                           2.       Details of each holder of petroleum authority in which the survey
(continued)                                   was conducted:

Question 2
Insert the full name of each              Company Name/Surname
holder (including the “principal
holder”) and their ACN or
ARBN, where applicable, and               Given Name(s)
the percentage interest held in
the authority, in which the
survey was conducted. The                 ACN (if company)                             Percentage                 %
respective percentages must
total 100%. If insufficient space,
please attach list.                       Company Name/Surname


                                          Given Name(s)


                                          ACN (if company)                             Percentage                 %


                                          Company Name/Surname


                                          Given Name(s)


                                          ACN (if company)                             Percentage                 %


                                          Company Name/Surname


                                          Given Name(s)


                                          ACN (if company)                             Percentage                 %


                                                                              Total Percentage                    %

Question 3
Indicate the name and details of
                                     3.       Specify the name and address of the principal holder in whose
the principal holder, in whose
petroleum authority the survey                petroleum authority the survey was conducted:
was conducted.


                                          Full Name or
                                          Company Name

                                          Address




                                          Phone Number       (       )


                                          Fax Number         (       )


                                          E-mail
                                                                3
GUIDELINES                         4.       Details of operator:
(continued)
Question 4                              Full Name or
Indicate the name of the                Company Name
operator, previously nominated
by the principal holder of the
petroleum authority in which the        Address
survey was conducted.




                                        Phone Number        (       )


                                        Fax Number         (        )


                                        E-mail




Question 5                         5.       Details of executive safety manager:
Indicate the name of the
executive safety manager,
previously nominated by the             Full Name or
holder of the petroleum
authority in which the survey
                                        Company Name
was conducted.
                                        Address




                                        Phone Number        (       )


                                        Fax Number         (        )


                                        E-mail



Question 6                         6.       Detail the type of survey:
For example, seismic,
geophysical, geochemical,
geotechnical, aerial, etc.




                                   7.       Detail the identifying name or code for the survey:
                                     4

GUIDELINES
              8.    Describe the area that was surveyed in blocks/sub-blocks:
(continued)




              9.    Energy source (where applicable and if different to that previously
                    notified):




              10.   Magnetometer (where applicable and if different to that previously
                    notified):




              11.   Gravity meter (where applicable and if different to that previously
                    notified):):




              12.   Common Depth Point (CDP) coverage (Seismic):


                                         %       or                         Fold



              13.   Line spacing (Magnetics):




              14.   Station density (Gravity):




              15.   Actual date of commencement:
                                                               5
GUIDELINES
                                   16.      Actual completion date of the survey:
(continued)
Question 16
A survey is completed as soon
as all the raw data for the
survey has been recorded or
recovered.                         17.      ENDORSEMENT
17. Endorsement
The signature of a relevant          I confirm that the relevant sections of the Petroleum and Gas (Production and
technically competent officer is     Safety) Act 2004 or the Petroleum Act 1923 and their associated regulations have
required.
                                     been complied with, and that the information contained within this notification is
                                     true to the best of my knowledge.

                                     Signed this                      Day of                           ,   20




                                         Full Name and Position of Technically   Signature of Technically Competent
                                                  Competent Officer                            Officer



                                    When completed, this notice may be lodged at the following Brisbane
                                    office:

                                    Department of Mines and Energy
                                    Landcentre
                                    PO Box 1475
                                    Coorparoo DC Qld 4151
                                                            6

GUIDELINES                        GENERAL PRIVACY STATEMENT
(continued)
                                  The Department of Mines and Energy is collecting the Information on this form to
                                  assess your notice of completion of seismic survey or scientific or technical survey.
                                  This information is required under section 34 of the Petroleum and Gas (Production
                                  and Safety) Regulation 2004 or section 19 of the Petroleum Regulation 2004.

                                  Information collected on this form may be provided to other Queensland Government
                                  Agencies to assist in the processing of applications, where such disclosure is
                                  necessary for the effective management of the mineral resources and industry in
                                  Queensland. These agencies may include the Environmental Protection Agency, the
                                  Department of Primary Industries and Fisheries and the Department of Natural
                                  Resources and Water.

                                  For more information on Information Privacy, please contact the Privacy Contact
                                  Officer for the Department of Mines and Energy on (07) 324 73239.




                                                OFFICE USE ONLY

18.   Comments (if any):



ENTERED ON MINING
TENURES DATA               this                         day of                                            ,   20
BASE:




                           Name                                                      Signature

								
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