Application for a permit, as required under Section 12101, shall be made by filing a statement on forms prescribed by the State Fire Marshal. Such statement shall contain, but shall not necessarily be limited to, the following:
The name and address of the applicant.
The name and address of the employee or authorized representatives designated by the applicant as being responsible for the use, handling, storage, possession, or transportation of explosives for the applicant and whether the employee or authorized representative has been issued a blasters license by the Division of Industrial Safety to use or handle explosives.
The place where, and the purpose for which, the explosives are intended to be used, handled, stored, or possessed.
The type and amount of explosives for which application is made.
The signature of the applicant.
The number of times purchases may be made and the frequency of such purchases.
The routes, highways, and stopping places intended to be utilized in transporting the explosives.