| Borehole Number: |
| Prospecting Company: |
| Prospecting License No.: |
| Coordinates Type: |
| Coordinates Format: |
| Coordinates: N/A |
| Location: |
| Start Drill: N/A |
| End Drill: N/A |
| Borehole Type: |
| Drilling Method: |
| Sample Type: |
| Depth of Surface Casing: N/A |
| Azimuth: Degrees |
| Hole Inclination: N/A |
| Collar Elevation: N/A |
| Borehole Water Strike: N/A |
| End of Hole (Depth): N/A |
| Hole Diameter: N/A |
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