Road Use / Road Ban Permit

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Energy Company Details

Company Name*

Please pick the company that requires the Road Use Addendum or Road Ban Permit with ANC Timber Ltd.

Energy Company Contact*

Please enter your client contacts name

Energy Company Contact Phone*

Please enter your client contacts phone number

Energy Company Email*

Please enter an email address for you client contact. This email will receive a copy of the submitted form.

Site Details

Disposition Type

Pick from the list below for the disposition type. This is the Companies location they are headed to.

Disposition Number

Please enter the 6-7 digit disposition number you are headed to such as "220056" for MSL220056

Legal Location (From / Surface)

"From" for linear features like pipelines and roads, "Surface" Location for well sites

LSD

QTR

SEC*

TWP*

RGE*

MER*

Legal Location (To / Bottom hole)

To for the other end of a linear feature like a pipeline or road. Or the bottom-hole for a well

Well #

LSD

QTR

SEC

TWP

RGE

MER

Activity

Pick the type from the list that best describes the above location information you have entered

Activity Type*

Pick from the list. This is the Companies location they are headed to.

Project Name

Comments

AFE / CC #

Proposed Route

Please enter the ANC roads and their kilometers, you can enter as many ANC roads as are required. DLO930569 starts at Highway 947 at KM100 (0) headed west.

From KM	To KM	ANC road	Actions

There are no Roads.

Form Type

For Road Ban Permits choose "Report Road Use"

Report Road Use
Request Road Use Addendum
Notification of Construction

Report Road Use: Reporting travel along ANCs roads? Need to get a ban permit? Enter your details here. (Can also double for construction notification at the same time).

Request for Road Use Addendum: Do you need to setup consent to access to a new location? Re-entry? Additional drilling? Please complete this form. Once submitted this will be reviewed and you will be contacted with an addendum

Notification of Construction: Are you wishing to report construction? Please complete this form.

Request Road Use Addendum

Land Agent / Requesting Company*

Your File #

Contact Phone*

Contact Email*

This email will receive a copy of the submitted form

Approximate Start Date*

Wellsite*

Plant Site*

Gravel Pit*

Camp - Open*

Camp - Private*

Land Fill*

Facility*

Tower Site*

Storage Site*

Riser Site*

Pipeline*

Heliport*

Compressor Site / Battery Site*

Other - See Comments*

Other third-party request to included

Attach zip file

Accepted file types: zip, Max. file size: 300 MB.

Add my email to the road notification list

Please ensure you are traveling under a current road use agreement, this is mandatory. If you have questions regarding this please contact thirdpartyrequests@geoverra.com.

All Drivers, ensure you have a copy of the Rules of the Road in your vehicle and that these rules are adhered to Rules of The Road.

Report Road Use & Notification of Construction

Trucking Company*

Where you wish to have multiple companies use this same permit, please enter Company as "Various"

Contractor Name

First Last

Contractor Email*

Contractor Phone*

Approximate Start Date*

Approximate End Date*

Description of Activity / Reason for Entry*

Detailed description of the route

Number of Loads Expected*

3-DIGITS REQUIRED: 000. IE: 1 load = 001. When actual # unknown, enter an approx amount.

Vehicle / Load Description*

Is there salvage? Approximate number of loads.

Is road use for the transport out of produced fluids, grocery/garbage waste and/or in of potable water for human consumption?*

Yes
No

If the road is used during an active road ban, I agree to any potential fees incurred per the schedule here:*

I agree to fees

Add my email to the road notification list

Please ensure you are traveling under a current road use agreement, this is mandatory. If you have questions regarding this please contact thirdpartyrequests@geoverra.com.

All Drivers, ensure you have a copy of the Rules of the Road in your vehicle and that these rules are adhered to Rules of The Road.

Permit Number E

Permit Number H

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Name

This field is for validation purposes and should be left unchanged.

Energy Company Details

Site Details

Legal Location (From / Surface)

Legal Location (To / Bottom hole)

Activity

Request Road Use Addendum

Report Road Use & Notification of Construction

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Current Road Conditions