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SAN JOAQUIN COUNTY SHERIFF-CORONER <br /> �s 7000 MICHAEL CANLIS BLVD <br /> SE�l1�F FRENCH CAMP CA 95231 <br /> -.� 209-468-4400 <br /> EXPLOSIVES APPLICATION & PERMIT Less than 100 Ibs $329 X <br /> More than 100 Ibs$548 <br /> PERMIT NUMBER PERMIT DATE `f LC I ZS EXPIRATION DATE '"i IL 2 4' <br /> COMPANY NAME Tylor MCMlllans Well Service, LLC PHONE NUMBER (916) 761-5224 <br /> ADDRESS 9530 Hageman Rd. STE B349,Bakersfield,CA 93312FAX <br /> AUTHRORIZED REPRESENTATIVETylor McMillan E-MAILtylor@Wellblaster.Com <br /> BLASTER Tylor McMillan DL#B8586676 STATE CA LICENSE#9201 <br /> BLASTER ❑L# STATE LICENSE# <br /> BLASTER DL# STATE LICENSE# <br /> VEHICLE LICENSE BLASTER STATE CA MAKE FORD MODEL 250 <br /> VEHICLE LICENSE STATE MAKE MODEL <br /> VEHICLE LICENSE STATE MAKE MODEL <br /> TYPE OF EXPLOSIVE PETN Detonation Cord and Boosters QUANTITY >100LBS <br /> STORAGE ********* NO STORAGE IN SAN JOAQUIN COUNTY*** <br /> SAFE TRANSPORT ROUTE AS per DOT/CHP Regulationa <br /> HOWIWHERE USED Various Well sites Within County <br /> Unused explosives must be returned to the source, destroyed, or turned over to the permit issuing authority. (12108 <br /> HS) <br /> APPLICANT SIGNATURE PRINTED NAMETyIOr McMillan <br /> ATF CHECK DATE y I I C.� 1 Z� MCA LICENSE CHECK DATE I1 CJ <br /> ADDITIONAL CON DITIONSIRESTRICTIONIS 2✓t'� ! i�C_.� �P[Z�jy L�, <br /> (0 tor-rM ��y✓l9L �`' 1 [_��flFLL' ' fir, <br /> ISSUING AUTHOR TTY °�' c <br /> NAME/TITLE <br /> ORIGINAL TO PERMITEE <br /> COPY TO EOD FILE 12103 HS <br /> COPY TO EOD FILE 12103 HS <br />