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

• Mine Satety and Health ~inlstratlOn ~, `~~
Section I-Violation Data
1 Date Mo
0 Da
0 Yr 2 Time 124 Hr Cleckl
/
3
.3o 3 Citation
Order
Number
3630839
4. erxetl T
1 _ _
5. Ope o
r

I•-C-~
6. ~ne 7 Mme ID
S
O
z
7
IContractorl
a. Condition or Practice Ba. Written Notice 110391 ^
- I
-
- r

See Continuation F rm IMSHA Form 70003x1 ^
9. Violation A. Health
Other p g, Settion
of Act _ C Part~Section of
Title 30 CFR
~
6
Section II-Inspector's Evaluation
10. Gravity'
A. Injury or Illness (has) list: No Likelihootl^ Unlikely ^ Reasonably Likely Highly Likely ^
Occurred ^
B. Injury or Illness coultl rea~
sonably be expected to be' No Lost Workdays^ Lost Workdays or Restricted Duly Permanently
isabling^ Fatal ^
C. Significant and Substantial (See Reversal. Yes No ^ D Number o Persons Affectetl
11. Negligence (check onel
A. None ^ B. Low ^ C Moderate ^ D. High ^
Reckless Disregard ^
12. Type o! Action
' 13. Type of Issuance (check onel
Citation Order ^
Safeguard ^
14. Initial Action
D Written
A. Citation ^ B Order ^ C. Safeguard ^ Notice ^ E. Citation/
Order
Number F. D tetl Mo Da Yr
15. Area or Equipment

i6 Termination Due
A. Dace Mo
O /
(O Da
Z O Vr
O
/ g. Time (24
Hr. Clock)
8
Section III-Termination Action
17. Action to Terminate

18. Terminated
A. Date Mo Da Vr
B. Time (24 Hr. Clockl
Section I V-Automated System Data
19. Type of Inspection
(activity code)
D
D
Z 20. Event Number
~
3
Z
O 21 Primary or Mill
n ur ~ 23 4R umber
MSHA Form 70003, Mar g5 IRevisedl