Exploration Evaluation Geoscientist

DEPA RTM ENT OF M INE S A ND ENER GY

MTA Approved Form 21 Request to Examine / Sample Core Regulation 128

REQUEST TO EXAMINE / SAMPLE CORE

Request Date: Date of examination/sampling Sheet of

Location Core held: DarwinAlice Springs Company: Contact Name: Address: Phone No.: Fax No. Email Address:

Signature: Position:

PLEASE COMPLETE ONE FORM FOR EACH DRILL HOLE YOU REQUEST TO EXAMINE/SAMPLE

Drill Hole Name & Number.: Prospect/Location Name.: Tenement No.: 1:250 000 Map Sheet Name & Number.: Drilled by:

CORE & CUTTINGS – EXAMINATION/SAMPLING GUIDELINES

 A separate form must be completed for each drill hole you intend on examine/ sample. These forms are available from: o Minerals and Energy InfoCentre, 3rd floor Paspalis,Centrepoint Building, Darwin Ph: 8999 6443, or Arid Zone Research Institute, South Stuart Highway, Alice Springs Ph: 8951 8177 o Core Facility, 38 Farrell Crescent, Winnellie, Darwin. Ph: 8984 3036 o Core Facility, 16 Power Street, Alice Springs. Ph: 8952 9497 o From our website www.minerals .nt.gov.au/ntgs  Approval can be obtained from the relevant Core Facility Manager – this can be done verbally in the first instance, and written once you visit the Core Facility. Some core/cuttings intervals may be excluded from the sampling request if available material is limited.  Once approval has been obtained, arrange a date to examine/sample with the Core Facility Manager.  Clients examining/sampling large amounts of core are required to bring their own technical or labouring staff to retrieve and redeposit core trays, as well as cutting samples.  Clients are required to provide their own sample bags, marker pens and vials. Clients intending to cut large amounts of core must provide their own saw blade. Please check with Core Facility Manager for size of saw blades.  Clients can sample ¼ core, cut lengthways, and 1 teaspoon of cuttings. ¼ core and 1 teaspoon of cuttings must always remain with the department. Any unused /non destructed samples are to be returned to the Core Library, with all intervals clearly marked.  To enable us to improve the service we provide, it would be appreciated if clients visiting the Core Facilities could fill in the “Visitors Book”.

SAFETY FOOTWEAR MUST BE WORN AT ALL TIMES WHEN VISITING THE CORE FACILITIES

Approved for Sampling:

Request to Examine / Sample Core Page 1 of 2 Northern Territory Government, Rev. 02/12/2014 DEPA RTM ENT OF M INE S A ND ENER GY

Approval Date: Rack Location: MTA Approved Form 21 Request to Examine / Sample Core Regulation 128

Request to Examine / Sample Core Page 2 of 2 Northern Territory Government, Rev. 02/12/2014 DEPA RTM ENT OF M INE S A ND ENER GY

MTA Approved Form 21 Request to Examine / Sample Core Regulation 128

PLEASE COMPLETE ONE FORM FOR EACH DRILL HOLE SAMPLED

Date of Examination/Sampling: Drill Hole Name/No.:

Interval Sampled Core/Cuttings Details of Sample

Sampling Purpose: Geochemistry Petrology Other If other please specify:

Title number if intending to claim sampling costs under current exploration expenses ______

I agree to supply a digital copy of all results and reports and return all unused samples within six months of sampling and I have read and agree to abide by the NTGS core sampling policy I understand that further applications for sampling from your organisation may be declined if results have not been submitted

Name: Signature:

Institution/Company Name:

Department Head or Student Supervisor Name: ______Signature: (Student sampling requests must be signed by a permanent member of the academic staff)

DEPARTMENT OF MINES AND ENERGY USE ONLY Security: Core Location: Report No.: Date Recorded:

Request to Examine / Sample Core Page 3 of 2 Northern Territory Government, Rev. 02/12/2014