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

Mlne Safety and Health r~nisiratldn ~~`~
Section I-Violation Data
1 Datn Mo Da
a /
rv Vr 2. Time (24 Hr Gockl
/
O 3 Gtation
Order
Number 3 6 3 0 8 4 0
erved T
t 5. Op for 1j
s^CL.GC7f0K>-

i
in 7. Mine ID
O
S
-
O
~
(Contractor)
g. Conditi or Practice
8a. Written Noti 110391 ^

1

Qi
• ,

1

~ ~~ 7
/~'„"

See Continuation F rm IMSHA Form 7000-3a1 ^
9. Violation A. Health
Other ~ g Section
of Act _ C. Part/Section of
Title 30 CFR
S
6
~
/
/
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
Disabling^ Fatal
^
C. Significant and Substantial (See Reversal. Ves ^ No D Number o Persons Affected Q /
11. Negligence Icheck onel
A. None ^ 6. Low ^ C Moderate D. High ^
c Reckless Drsregard ^
12. Type of Action
/
O
' 13. Type of Issuance Icheck onel
Citation Order^
Safeguard^
14. Initial Action
D Written
A. Gtation^ B. Order^ C. Safeguard ^ Notice ~ E. Citation/
Ortler
Number F. atetl Mo Da Yr
15. Area or Equipment

16. Termination Due Mo
A. Dale d Da
~ Q Vr g Time 124
Hr, Clock)
D '
Section II I-Termination Action
17 Action to Terminate

18. Terminated
A. Dale Mo Da Vr
B. Time 124 Hr. Clock 1
Section IV-Automated System Data
19. Type of Inspection
lactivi code)
O
Q 20. Event Number
3
d 21. Primary or Mill
to Y- 23 AR Number
MSHA Form 7000-3, Mar B5 IR v ed)

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