Santa Cruz — Explosive Permit

Source: https://shf.santacruzcountyca.gov/Portals/1/County/sheriff/formsdocs/explosive_permit%20SCSO.pdf

Santa Cruz County Sheriff's Office 5200 Soquel Ave., CA 95062 Tel: (831) 454-7600 Fax: (831) 454-7604 Explosive Permit Application Requirements

1. Photocopy of your State Blaster’s License through the State of California Licensing Board

2. Photocopy of your Driver’s License

3. Photocopy of Liability Insurance

4. Completed Explosive Permit Application, including thumb print.

5. Photocopy of your current Certification of Eligibility from the California Department of Justice.

6. Permit fee of $100.00 (non-refundable).

7. Any additional restrictions or conditions to the issuance of the Explosive Permit.

Standard requirement for the use of high explosives within the County of Santa Cruz

• Permittee must document each explosive blast with a “Shot Report” describing weather conditions, distance to nearest structure, time of explosion, type of explosives, initiation system, and seismograph information. A seismograph is to be used to document the ground disturbance effect of each detonation. • A permittee will provide written notification to surrounding residents and/or commercial establishments of their intention to use high explosives in the area. The notification area will adhere to the recommendations of the federal and state laws for scaled distance. The written notification must contain the following information: 1. The name, address, and telephone number of the permittee. 2. The normal hours of operation. 3. The type of warning device to be used and associated description of each individual warning signal with its meaning. 4. The nature and/or type of activity resulting from the use of high explosives which could impact individuals and property. • Permitee must notify the Santa Cruz County Sheriff Dispatch Center one hour prior to blasting at (831) 471-1121. • The issuing authority of this agency or their designee may add any additional requirements and/or conditions to the Explosive Permit. These requirements or conditions will be written on Page 2 of the explosive Permit when returned to applicant after approval. • The issuing authority or their designee has the authority to inspect any work site and/or review any documentation to ensure the permittee is complying with the requirements of their Explosive Permit.

Chris Clark, Sheriff of Santa Cruz County

Santa Cruz County Sheriff's Office, 5200 Soquel Ave. Santa Cruz, CA 95062 Scsheriff.com | P. 831-454-7600 | F. 831-454-7604

EXPLOSIVE SANTA CRUZ COUNTY FOR SHERIFF'S OFFICE SHERIFF'S OFFICE USE ONLY PERMIT 5200 Soquel Ave. APPLICATION Santa Cruz , CA 9562 X - (831) 454-7600 Permit Number

SECTION 1

PERMITTEE INFORMATION Form to be filled out completely prior to review and issuance of permit. Date:

NAME (Last, First, M.I.) DOB RIGHT THUMB PRINT

RESIDENCE ADDRESS STATE ZIP CODE

BUSINESS ADDRESS STATE ZIP CODE

RESIDENCE PHONE BUSINESS PHONE BLASTER'S LICENSE NO: STATE OF REGISTRATION

DRIVER'S LICENSE NO. STATE VEHICLE INFORMATION ACTIVITY PERFORMED

MANUFACTURE
VEHICLE LICENSE NO.
TRANSPORT OF EXPLOSIVES USE EXPLOSIVES SELL/DISPOSE
MAKE: YEAR:
STORAGE OF EXPLOSIVES STORE PARK VEHICLE

OTHER (Explain below) MODEL: COLOR: RELEASE/TRANSPORT OPERATE TERMINAL

ADDITIONAL AUTHORIZED PERSONNEL NAME: (Last, First, M.I.) DOB DRIVER'S LICENSE NO./STATE

MAILING ADDRESS: STATE ZIP CODE

AUTHORIZED DUTIES: Use Receive and/or Transport Sell or otherwise dispose Manufacture Park Vehicle Operate Terminal Store BLASTER'S LICENSE NO. STATE OF REGISTRATION

TYPES OF EXPLOSIVES TYPE OF FIRING Brand Name Explosive Class (A/B) Quantity (lbs.) SYSTEM USED

1. Non-Electric Firing System

Location where materials are used: Reason for use of materials: Address: Explain:

Location where materials are stored: Address:

How are materials stored: Other information: Type of containment:

Travel route and safe stopping places:

SECTION 2 INSURANCE

Before the permit can be issued, the applicant must file a public liability insurance policy in the amount of $ _________________________________ for the purpose of payment of all damages to persons or property which arise from or are caused by the conduct of any act authorized by this permit.

I, the undersigned, certify that I understand and will abide by all Federal, State, and local laws and ordinances, rules or orders to perform those acts noted herein. I also understand that all unused inventory covered by this permit on or before the expiration date will be disposed of in accordance with Health and Safety Code Section 12087.

(Signature of Applicant) (Date)

I will dispose of the materials in the following manner: Returned to their source. Turned over to the authority issuing this permit. Totally destroyed. Re-apply for new permit.

SCSO Explosive 4/25

EXPLOSIVE SANTA CRUZ COUNTY FOR SHERIFF'S SHERIFF'S OFFICE OFFICE USE ONLY PERMIT 5200 Soquel Ave. APPLICATION Santa Cruz, CA 95062 X - (831) 454-7600 Permit Number SECTION 3 PERMIT: Approved Approval Date: ______________________

Denied Expiration Date: _____________________

The permittee is limited to perform those activities as described within this permit. Permit is non- transferable. Changes to any part of this permit will require issuance of a new permit. Please note any additional conditions described below. Chris Clark, Sheriff-Coroner Issuing Authority

By: Bomb Team Commander

SECTION 4 REQUIREMENTS: Standard requirements can be met: Yes No Blasting times shall be restricted between the hours of: ___________ to ___________ Additional Conditions:

For additional information contact the Santa Cruz County Sheriff's Office

SECTION 5 DISTRIBUTION: Issuing Authority

Copies: Permittee
DOJ attn: COE, P.O. Box 160487 Sacramento, CA 95816-0487
Santa Cruz Sheriff's Office Bomb Squad
Fire Chief - Where explosives to be used/stored (CDF- Felton)

NOTE: When transport of explosives is noted forward to:

California Highway Patrol
Motor Carrier Safety Section
P.O box 942898
Sacramento, CA 94298-001

SCSORPDExplosiveForm) 4/25