REV95425

• Permit No: M1985029
• IBM Index Class Name: Revision
• Doc Date: 7/25/1994
• Type & Sequence: AM3
• Media Type: D
• Archive: No

~~
Mine Safety and Health Administrati n
Section I-Violation Data
1 Date Mo
0 Da
02 Yr
90 2 Tune 124 Hr Clockl
/ O
Z
o 3, Citation
Order
Number
3630823
erved T ~ // n
.Qr / r //q_ t 5. razor i
6 Mine 7. Mine ID
o
`
J
O
Z
~'
ICOntractorl
8 Condition or Pracrice Ba. Written Notice 110391 ^
7000 - ~

MsNA

/98 czo ~ .f / 90

See Continuation F rm IMSHA Form 7000.3x1 ^
9. Violation A. Health
Other ~ g. Section
of Act
/
0
3 C. Part/Section of
Title 30 CFR
~
~
3
Section II-Inspector's Evaluation
10. Gravity
A. Injury or Illness (has) list: No likelihood Unlikely ^ Reasonably Likely^ Highly Likely ^
Occurred ^
8. Injury or Illness could rea~
sonablY be expected to be: No Lost Workdays Lost Workdays or Restrictetl Duty^ Permanently
isabling^ Fatal ^
C. Significant and Substantial (See Reverse) ~ Ves ^ No D. Number of ersons Affeaetl O Q
11. Negligence Icheck one)
A. None ^ B. Low ^ C Moderate D. High ^
Reckless Disregard ^
12. Type of Action
o
' 13. Type of Issuance Icheck one)
Citation ~ Order^
Safeguard ^
14, Initial Action E. Citation/
D. Written ~ Order
A. Citation ^ B. Order ^ C. Safeguard ^ Nonce ^ Number F Da ed Mo Da Yr
15. Area or Equipment

16. Termination Due
A. Date Mo
0 ~ Da
/ / Vr
9 D B Time 124
Hr. Clockl
o
Section III-Termination Action
17 Action to Terminate

16. Terminated
A. Dare Mo Da Vr
B. Time (24 Hr. Clock 1
Section IV-Automated System Date
19. Type of Inspection
(activity code)
D
O
/ 20. Event Number
0
3
4
3 / 21 Primary Or Mill
22 Si A 23 AR N tuber
2
MSHA Form 7000-3, Mar 851Revisc{II~