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Dv co~D <br />A~ 0 <br />-o:sn4 <br />1= O <br />V. 41,/-,y~ 0 <br />~ V\~~~!~ <br />rM16 ~ <br />RAC HARD D. LAMM <br />Govcw now <br />C~ORADO DIVISION OF MIS <br />DEPARTMENT OF NATURAL RESOURCES <br />1845 Sharman Slr eet. Denver. Cola ado 80203 Telephone 8923401 <br />nur man R. Blake. Drtect or <br />Coal Mine Inspection <br />OPERATOR'S MONTHLY REPORT <br />For the month of (7CT , 19~ <br />Mine }~ J F ~ P1~ ~ (Yl ,r 1~ Address P•o. F~~rv s ~'; ~~{ • ~:=F 'County ~~T I <br />Names of: Superintendent~9~?!r.,,~ ~. ~' =;c Mine Foreman ~SnPi.I1rJ ~ ~TF=tc <br />Company5~.~. ~~ A,_•r (1,~ „)~.~,_ 'r ~ . Address ~ ~, n0 c r). ~rscir. ~: =' nor. ..:F <br />Pien Em to ed M <br />-H Da Total <br />Surface Underground Total an <br />ours <br />Worked ys <br />Worked Production <br />.~ ~ la- ~ ~o~ a~ ass 7.3~ <br />Date <br />All accidents of one day or more lost time must be reported. <br />Name Cause of Accident Time Lost Due To Injury <br />~(~ I\~'ULrr rJr <br />Signature <br />This Report Is Due In This Office By The 15th Of Each Month <br />CMI 5 (Rev. 10-75) <br />