REV95425

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

Mlne Solely and Health Adminisiratio ~~%
Section
1 Dare Mo
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66. M 7 Mine ID
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IContractorl
8. Condition or Practice Ba. Written Notice (10381 ^

l

See Continuation F m (MSHA Form 7000~3a1 ^
9. Violation A. Health
Safety p
O[her p g Section

Of Act _
C. Part/Segion of
Title 30 CFR
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o

~
2
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Section 11-Inspector's Evaluation
10. Gravity:
A. Inlury or Illness (has) list: No Likelihood Unlikely ^ Reasonably Likely^ Highly Likely ^
Occurred ^
B. Injury or Illness coultl rea-
sonably be expected to be: No Last Worktlays Lost Worktlays or Restricted Duty ^ Permanently
isabling ^ Fatal ^
C. Significant and Substantial (See Reversal: Ves ^ No D Number of arsons Affected Q o
11. Negligence (check onel
A. None ^ B. Low ^ C Moderate ~ D. High ^
.Reckless Disregartl ^
12. Type of Action
o
~ 13. Type of Issuance (check one)
Citation Order^
Safeguard^
14. Initial Action
D. Written
A. Citation^ B. Order^ C. Safeguard ^ Notice ^ E. Citation/
Order

Number F. D ed Mo Da Yr
t5. Area or Equipment

76. Termination Due
A Corte Mo

Q S Da

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B. Time 124
Hr. Clockl

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Section III-Termination Action
17. Action to Terminate

18. Terminated
A. Date Mo Da Yr
B. Time 124 Hr. Clockl
Section IV-Automated System Data
19. Type of Inspection
lactivit el
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O
/
t 20. Even[ Number
Q
3
/ 21 Primary or Mill
2 ur ~`
~ 23 AR umber
9
MSHA Form 7000-3, Mar g5 IRe ~ )