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 Administratio
Section I-Violation Data
1 Date ~ o
(/ Da
O Z Vr
9 2. Time 124 Hr Clockl
f / D 3 Citation
Order
Number 3 6 3 0 8 2 9
Served To 5. for ~
6. Mine ~ D_ _ w - -
~k./ 7 Mine ID
D
S
O
il
T
z
7
IContractorl
8 Con 'ton or Practice Ba. Written Nonce (1039) ^
~~ ~

ti~

See Continuation F rm IMSHA Form 7000~3a) ^
9. Violation A. Health
SaletV ^
Other ^ 8. Section
of Act _ C Part/Secion of
Title 30 CFR
S
~
.3
Z
Section II-Inspector's Evaluation
10. Gravity:
A. Injury or Illness (has) list: No Likelihood^ Unlikely Reasonably Likely^ Highly Likely^
Occurred ^
B. Injury or Illness could rea-
sonably be expected to be: No Lost Workdays^ Lost Workdays or Restricted Duty^ Permanently
isabling^ Fatal,
C. Significant and Substantial (See Reversal: Ves ^ No D Number o Persons Affettetl O O
11 . Negligence (check onel
A. None ^ B. Low ^ C. Moderate D. High ^
Reckless Disregard ^
12. Type of Attion
1
O
' 13. Type of Issuance (check one)
Citation Order^
Safeguartl^
14. Initial Action
D. Written
A. Citation ^ B. Order ^ C. Safeguartl ^ Notice ^ E. Citation/
Ortler
Number F. D tad Mo Da Vr
15. Area or ErluiPment

16. Termination Due
A. Date Mo
D S Da
~ ~ qVr
/ D g Time 124
Hr, Clockl
O
~ ^
fJ
D
Section III-Termination Action
17 Action to Terminate

18. Terminated
A. Date Mo Da Vr
B. Time (24 Hr. Clockl
Section IV-Automated System Dete
19. Type of Inspection
lacuvity code)
D
O
/ 20. Event Number
3 21. Primary or Mill
22. Sig ~/,' 23 AR umber ^
MSHA Form 7000-3, Mar 85 IRevisedl V