2. Seismograph Location Distance (Feet) and Direction (Degrees) from Blast

5600-FM-BMP0340 10/2013

BLAST REPORT

Responsible Party Information/Date/time
Permittee: / Blasting Contractor:
Permit #. / Date: / Time: A.M. P.M.
Permit Municipality/County /
Explosives LOADING and AMOUNTS
Type of Material / Stemming / Min. (ft.) Max. (ft.)
No. of Holes / Type Stem.
Diameter / Min. (in.) Max. (in.) / No. of Rows (burden):
Depth / Min. (ft.) Max. (ft.) / Burden / Min. (ft.) Max. (ft.)
Sub Drilling / (ft.) / Spacing / Min. (ft.) Max. (ft.)
Max No. Decks/Hole / Maximum No. of Holes Per Delay
Deck Separation / Min. (ft.) Max. (ft.) / Max. Lbs./Delay Less Than 8 ms. / (lbs.)
Wt./Deck / Min. (lbs.) Max. (lbs.) / Maximum Powder Factor / (lbs/YD)
Explosives (Mfr/Type) / Amount (lbs) / Detonators (Mfr/Type/Delay MS) / Amount (qty)
Total / Total
Were Mats Used? Yes No / Describe matting:
Type of initiation Elec. Non-electric Electronic Other Explain Other
Scaled Distance/Blast location
Distance (feet)/Direction (degrees) to Closest Building/structure /
Description of Closest Building/structure and Address (if applicable)
Scaled Distance Ds = D/ÖW / Blast Site (lat/lon) /
seismograph monitoring Yes No
1. Seismograph Location Distance (feet) and Direction (degrees) from Blast / /

2. Seismograph Location Distance (feet) and Direction (degrees) from Blast /

Description of Seismograph Location / Description of Seismograph Location
Location (lat/lon) / / Location (lat/lon) /
Seismograph Operator (print) (sign)
Seismograph Operator (print) (sign)
Weather
Weather (description, general) Temp Wind Direction Wind Velocity (mph)
blast area description
Remarks:
BLASTER-IN-CHARGE/BLAST CREW
Blaster-in-charge (print) (sign) / BL-
Blasting Crew

Date: Time: A.M. P.M. Permit #:

Blast Hole Layout and Timing Diagram

Typical Borehole Layout 1. Typical Borehole Layout 2.

Date: Time: A.M. P.M. Permit #:

Additional Remarks:
additional seismograph monitoring
3. Seismograph Location Distance (feet) and Direction (degrees) from Blast / /

4. Seismograph Location Distance (feet) and Direction (degrees) from Blast /

Description of Seismograph Location / Description of Seismograph Location
Location (lat/lon) / / Location (lat/lon) /
Seismograph Operator (print) (sign)
Seismograph Operator (print) (sign)

- 3 -