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U.S.

FISH AND WILDLIFE SERVICE


EXPLOSIVES AND BLASTING AUTHORIZATION

Name: ________________________________________________________
Has satisfied all FWS explosives training requirements and is authorized to execute blasting activities in
compliance with FWS explosives and blasting policies.
Employee Duty Station: ___________________________________________
Date: _____________________________________
This authorization expires 3 years from date of issue.

Authorized blasting:

Tree

Beaver Dam

Rock/boulder

Other : ___________________________

Issued by: (print name)_________________________;


Supervisor

Manager

Signature: ________________________
Project Leader

Regional Safety Office concurrence:


Name:__________________________________;

Signature:________________________
FWS Form 3-2402, 09/10

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