• Mining Operations Destruction Certification Form

    Use this form to certify the destruction of mining operations assets, materials, or records and document the site, items, method, and witnesses.

  • Destruction Event Details

  • Destruction / Certification Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Time of Destruction*
  • Reason for Destruction*

  • Items and Materials Destroyed

  • Destroyed Items and Materials*

  • Destruction Method and Handling

  • Destruction Method*
  • Date and Time Destruction Completed*
     - -
    2 digit month, 2 digit day, 4 digit year

  • Witnesses, Certification, and Submission

  • Witness Name(s)*
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