Blasting Forms

Revised: September, 2023
Surface Coal Mine Blaster Certification renewal requires the following: Completed renewal application form, $30.00 non-refundable fee, documentation of one-year (240 workdays) of active blasting experience in the last three (3) years or DMR eight (8) hour training class, legible copy of driver’s license or photo identification, copy of current Fire Marshal’s card and ATF employee possessor letter of clearance, and documentation of completion of twelve (12) hours refresher training within the last three (3) years from a program or combination of programs approved by this office.

The documentation submitted must show total hours attended.

• EB-30R: Application for Renewal of Surface Mine Blaster

Revised: October, 2022
Failure to comply with the fee requirements of W.Va. Code §22-3 and 199CSR1 by the due date may result in permit suspension or revocation in accordance with W.Va. Code §22-3-17.

• Blasting Fee Affidavit

Revised: November, 2019
The blast log must be completed within 24 hours of the shot. If there are any unusual events associated with the blast, the log must be completed that day by the blaster-in-charge before leaving the mine site. A shot number should be used to consecutively number each blast for a permit.

• EB-37: Blast Log
• EB-37: Blast Log Instructions

Revised: April, 2017
Public notice of blasting operations.

• EB-38: Blast Ad
• EB-38A: Blast Notification List

Revised: March, 2017
Sample notification letter for pre-blast surveys. The law requires that you offer a pre-blast survey to every resident and owner of a building within the pre-blast survey radius for this mine permit. The pre-blast survey will record and document the physical condition of the dwelling or structure prior to blasting on this permit.

• EB-39: Blast Notification Letter
• EB-39A: Pre-Blast Survey Request
• EB-39B: Pre-Blast Survey Waiver
• EB-39C: Pre-Blast Survey Affidavit
• EB-39D: Pre-Blast Survey for County Clerk Filing

Revised: April, 2017
All pre-blast surveys must include the Pre-Blast Survey Form (EB-40), Request for Pre-blast Survey Form if available (EB-39A), map that identifies the structure, and a letter from insurance company authorizing the surveying company to do the pre-blast survey. All surveys must include an owner's name. Tax records from the courthouse will provide a name of the individual paying taxes on the structure. Surveys will be compared with Section T of the Surface Mine Application to verify that all structures have a pre-blast survey, waiver or affidavit.

• EB-40: Pre-Blast Survey Form

Revised: April, 2017
This form (hard copy) must be completed and submitted to the Division of Mining and Reclamation with each batch of surveys.

• EB-41: Pre-Blast Survey Inventory Form ​