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~. <br />~3~y ~ ~ y ~ U. S. Department of Labor <br />Mine Safety and Health Administration <br />INSPECTION INFORMATION SHEET <br />Operation Address: Identification No.: ~ <br /> <br /> <br /> <br />D~ 4 L 7 <br />q <br />/ Inspection Date(s) p,S - 1J <br />~ <br />~D ~ <br />~'i / (y Inspection Code: <br />~y'~/1 _ <br />~~^-~ ~--0 ~'O "St z ~ <br /> <br />p~ / <br />Telephone: ~ ~ % S.3(p ' z 3 ~'¢ <br />Company: -~~ [ ] Health Samples co <br />and sent to labor <br />analysis. <br />Type: dust fiber <br />(Spe <br />t1~ lected <br />tory for <br /> <br />fume as <br />ify) <br />Mine Name• <br />City: County: <br />Location: /~ State: <br /> <br />Type of Mine: Mining Method: Prod ct: <br />do. Employees: Work Schedule: Hours/Shift Shifts/day <br />~ , <br />Operating officials: Days/week! <br /> <br />Union Official & Address: /1~% <br /> <br />INSPECTION PARTY• <br />Company: <br />~ ~ <br /> <br />Union Rep(s) : Dl/~ <br /> <br />I4iner's Rep(s) : it/ <br /> <br />7- <br />MSfiA Inspector(s). ~'~ <br /> <br />Other: <br /> <br />No. of outstanding Citations: <br />~. of Outstanding Orders: Z <br />