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Mine Safety and Health <br />~~J <br />1 Dale M~ opa V D <br />9 2 lime 124 Hr Clockl ~ / ~ 3. Citation <br />Order <br />Number 3 6 3 0 8 3 0 <br />erved T r r 5. OPer r -/ ~ <br />6. Min 7. Mine ID <br />Q <br />- <br />Z <br />~ <br />(Convactorl <br />8. Con ion or Practice Sa. Written Notice 11038) ^ <br />8N <br /> <br />~~~ <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />See Continuation orm (MSHA Form 7000~3a1 ^ <br />9. Violation q. Health <br />O he~ ~ g. Section <br />of Act _ C. Part/Section of <br />Title 30 CFR <br />~ <br />~ <br />~ <br />~ T <br />.1 <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 coultl rea- <br />sonably be expected to be~ No Lost Workdays^ Lost Workdays or Restricted Duty^ Permanently <br />Disabl~ng^ Fatal <br />C. Significant and Substantial ISee Revarsel: Ves ^ No D. Number Persons Alfetted Q <br />11 . Negligence Icheck one) <br />A. None ^ B. Low ^ C. Moderate ~ D. High ^ <br />E Reckless Disregard ^ <br />12. Type of Action <br />' 13. Type of Issuance Icheck one) <br />Citation Order ^ <br />Safeguard ^ <br />14. Initial Action D. Written <br />A. Citation^ B. Order^ C. Safeguard ^ Notice ^ E. Citation/ <br />Order <br />Number F. ated Mo Da Vr <br />15. Area or Equipment <br /> <br /> <br />16. Termination Due <br />A. Date Mo <br />D S Da <br />/ g Vr <br />9 O g. Time (24 <br />Hr. Clockl <br />Q <br />Section III-Termination Action <br />17. Action to Terminate <br /> <br /> <br /> <br />18. Terminated <br />A. Data Mo Da Vr <br />B Time 124 Hr. Clockl <br />Section IV-Automated System Data <br />19. Type of Inspection <br />lactivity codel <br />O <br />/ 20. Event Number <br />D 3 <br />3 <br />I 21. Primary or Mill <br />22. Si r J 23 A Number <br /> <br />MSHA Form 7000-3, Mar $5 IRevised~ <br />