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 Adminisiratior~ ~~~
Section I-Violation Data
1 Date Mo
p Da
olz Vr
9 0 2 Time 124 Hr Clockl
/
O
3
0 3. Citation/
Order
Number
3630824
Serve Tp~ r ~
iGl 5.0 ator
I
6. M-inert
/J // ~
/~'N
'o-
e
~
~~
/
~ 7. Mine ID
!
/
-
O
LJ
7
~
IContraet Orl
8 Con
d
i
t i
o
or
Pr
aice Ba. Written Notice 110391 ^
7 0 -Z

.r

9 0 '

is /9 90,

See Continuation Fo m (MSHA Form 7000-3a1 ^
9. Violation A. Health
Other ^O B Section
of Act
p
3 _ C. Part/Section of
Tide 30CFR
.S
~
~
3 ~s
d
Section II-Inspector's Evaluation
10. Gravity:
A. Injury or Illness (has) (isl: No Likelihood Unlikely^ Reasonably Likely^ Highly Likely^
Occurred ^
B. Injury or Illness could rea-
sonably be enpected to be: No Lost Workdays Lost Workdays or Restricted Duty^ Permanently
isabling^ Falal ^
C. Significant and Substantial (See Reversal: Ves ^ No D Number of arsons A+fecZed o f~
11. Negligence Icneck onel ,yam
A. None ^ B. Low ^ C. Moderate W D. High ^
~`
Reckless Disregard ^
12. Type of Action h
t'/
-
-
~
- 13. Type of Issuance (check one)
Citation Order^
Safeguard ^
14. Initial Action
D. Written
A. Citation ^ B. Order ^ C. Safeguard ^ Notice ^ E Citation/
Order
Numlaer F. Da etl Mo Da Yr
15. Area or Equipment

16. Termination Due
A. Date Mo
o S Da
/ ~ Vr
9 o B Time (24
Hr. Clockl
Q
~
~
Section III-Termination Action
17. Action to Terminate

18. Terminated
A. Date Mo Da Vr
8. Time 124 Hr. Clock)
Section I V-Automated System Data
19. Type of Inspection
lactivity rode
~
J 20. Event Number
Q
3
g'
3
r 21. Primary or Mill
22. Sig 23 AR umber l
MSHA Form 7000-3, Mar 85 (Revis$11 f