Powder Count Template - A

• Date of Count:

  Date

• Location of Count:

• BEAT:

• Supervisors:

EXPLOSIVES

Explosive

• Material #:

• Material Description:

• Unit of Measure:

• Amount:

• Unit:

• Condition of Magazine & Explosives (as required by section 127 2a)

FLAMMABLE REFUSE REPORT

• Shaft Station:

• Refuge Station:

• Other Areas:

• Signature:

  Sign