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., ~. ~ v .~.. ~_ ~ v..r r~.µn~un~.w yr guar <br />Mine Sate[y antl Health Administfatio III IIIIIIIiiIIII III <br />n ggg <br />Section I-Violation Data <br />1. Date Mo t)a <br />o Z Vr <br />90 2, Time 124 Hr. Clockl <br />0 <br />9 <br />3 3. Citation <br />°rdQ1 <br />Number ! <br />3630821 <br />rvetl T , r 5. Ope , <br />6 ine 7. Mine ID <br />d <br />r <br />z <br />IContractorl <br />8. C d i r or Practice 8a. Written Norice 110381 ^ <br /> <br /> <br />t <br /> <br />r <br /> <br /> <br /> r <br /> <br />r1ECLAMAT ON ! 1 1~^ <br /> <br /> <br />See Continuation F rm IMSHA Form 70003x1 ^ <br />9. Violation A. Health <br />Othe~ p R. Section <br />of Act _ C. Part/Section of <br />Title 30 CFR <br />5 <br />~ <br />~ <br />~ <br />Q <br />Q <br />Section II-Inspector's Evaluation <br />10. Gravity: <br />A. Injury or Illness (has) list: No Likelihood Unlikely ^ Reasonably Likely^ Highly Likely^ <br />Occurred <br />B. Injury or Illness could rea• <br />sonablV be expectetl to ba. No Lost Workdays Lost Workdays or Restrictetl Duty ^ Permanently ^ <br />Disabling^ Fatal <br />C. Significant antl Substantial (see Reversal: Ves ^ No D. Number o Persons Af(ettet! D Q <br />11 . Negligence (check coat <br />A. None ~ B. Low ~ C. Moderate D. High ~ <br />E. Reckless Disregard <br />12. Type of Action <br />/ <br />Q <br />- <br />~ <br />' 13. Type of Issuance (check one} <br />Citation Order <br />Safeguard <br />14. Initial Action <br />D. Written <br />A. Citation ~ B. Order ~ C. Safeguartl ~ Notice E. Citation/ <br />Order <br />Number F. ated Mo Da Yr <br />15. Area or EQuipment <br /> <br /> <br />16. Termination Due <br />A. Data Mo <br />O S Da <br />o Z ~'r <br />9 o 0. Time 124 <br />Hr. Clock 1 <br />p <br />9 <br />3 <br />S <br />Section 111-Termination Action <br />17. Acti to Termiltete <br /> <br />s <br /> <br />18. Terminatr~ <br />A, Date Mo <br />O Da <br />Q z Vr <br />~ O <br />B. Time 124 Hr. Clockl <br />D <br />~ <br />? <br />J <br />Section IV-Automated System Date <br />19. Type of Intpettion <br />lecbyi code) <br />p <br />O <br />/ 20. Event Number <br />D <br />.~ <br />3 <br />/ 21. Primary or Mill <br /> t re ~ A 23 A Number <br />MSHA Form 70003. Mar 85`(~evisedl <br />