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• Mine Salety anD rteann ~lnlsualloh '" l ~~~ <br />Section I-Violation Data <br />1 Oate Mo <br />b S Da Vr <br />OLL-9l~ 2. Lme 124 Hr Clockl <br />0 <br />9 3 Gtat,on <br />order <br />Number <br />3630822 <br />Served o <br />r 5. er for <br /> <br />r <br /> <br />Y ' <br />6 M~ e ~ 7. ine ID - Q ~ ~ z IContranorl <br />g. ndiUOn r Practice ga. Written Nouce 110391 ^ <br />ZQOO-- <br /> <br />t <br />i / <br /> <br />/~ r r <br />/~S 10 <br /> <br />9~7 ~~ <br /> <br /> <br /> <br /> <br /> <br />See Continuation F m (MSHA Form 70003x1 ^ <br />9. Violation A. Health <br />ether ~ g Section <br />of Att <br />/ <br />~ <br />9 _ C Part/Senion of <br />Title 30 CFR <br />~ <br />~ <br />2 <br />0 <br />Section II-Inspector's Evaluation <br />10. Gravity' <br />A. Injury or Illness (has) list: No Likelihood Unlikely ^ Reasonably Lik ely^ Highly Likely ^ <br />Occurred ^ <br />B. Injury or Illness could rea~ <br />sonably be expected to be: No Lost Workdays Lost WorkdaYS or Restricted DutY^ Permanently <br />isabling^ Fatal ^ <br />C. Significant antl Substantial (See Reversel: Yes ^ No D Number of ersons Attested <br />11. Negligence Icheck one) <br />A. None ^ B. Low ^ C. Moderate D. High ^ <br />.Reckless Disregard ^ <br />12. Type of Action <br />~ 13. Type of Issuance Icheck onel <br />Citation Order^ <br />Safeguard^ <br />14. Initial Action E. Citation/ <br />D. Written Order <br />A. Ci[ation^ B. Order^ C. Safeguard ^ Notice ^ Number F. Da ed Mo Da Vr <br />15. Area or Equipment <br /> <br /> <br />16 Termination Due <br />A. Date Mo <br />Q S Da Yr <br />D z 9 g Time 124 <br />Hr Clockl <br />~ <br />/ '~ <br />Section III-Termination Action <br />17 A i to Terminate <br /> r <br /> <br />i <br />1g. Terminated <br />A. Date Mo <br />S Da <br />o z Vr <br />9 o <br />R. Time (24 Hr. Clock) <br />/ <br />D <br />s <br />Section IV-Automated System Data <br />19. Type of Inspection <br />(activity co 1 0 , 20. Event Number O T <br />.! / ~ 27 primary or MITI <br />22 r 23 AR tuber <br />MSHA Rnrm ](10f13 Mar RF 1Ravic. 1 i <br />V I l~ <br />