GENERAL30496

• Permit No: M1985029
• IBM Index Class Name: General Documents
• Doc Date: 6/22/1990
• From: US DEPT OF LABOR
• To: MLRD
• Media Type: D
• Archive: No

Section I-Vlplatlpn

1. Date Mo
a~ Da
o G Vr
9 0 2. Time 124 Hr Cbck) / .3 / 3 Cicalion
Drder
Number 3 6 3 0 8 3 8

erved T r
5. ra or I _

r
6 in 7 Mine ID
-
O
Z
~
(Contractor)
8. Co i ion or Practice Ba. Wri en Notice 110391 ^
A n / i
rte./ ~+C
~

I
t

r
1

See Continuation F rm IMSHA Form 7000~3a1 ^
9. Violation A. Health
Other ~ g. Section
of Act _ C. Part/Section of
Title 30 CFR
~
''4
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
isabliny^ Fatal ^
C. Significant and Substantial (See Reversal: Ves ^ No D Number of Persons Affected
1 I. Negligence (check onel
A. None ^ B. Low ^ C Moderate D. High ^
Reckless Disregard ^
12. Type of Action
~ 13. Ty Pe of ssuance (check onel
Citation Order^
Safeguard^
14. Initial Action
D. Written
A. Citation^ B. Order ^ C. Safeguard ^ Notice ^ E. Citation/
Order
Number F. D tad Mo Da Vr
15. Area or Equipment

16. Termination Due
A. Date Mo

D Da

2 0 Vr

9 0 8. Time (24

Flr. Clock)

Q
p
p
Section II I-Termination Action
i 7. Action to Terminate

18. Terminatetl
A. Dale Mo Da Vr
B. Time 124 Hr. Clock I
Section IV-Automated System Data
19. Type of Inspection
lectivity del
D
Z 20. Event Number
d
3 21 Primary or Mill
22. re ~ 23 AR umber
MSHA Form 7000-3, Mar 85 (Rev~59tl1