|
Quarterly Mine Employment U.S. Department of Labor //`
<br />and Coal Production Report L113ii flii?i Mlne Safety and Health Adminisiration •
<br />Do Not Write in This Space O M. B. Number 1219-0006; Approval Expires July 31, 198B.
<br /> This report Is requlratl by law (30 U.S.C. 5 813: 3o GF. R, Parl 50). Failure to report can result In the mslilulion of a civil action for relief antler 30 U.S.C.
<br />~~~ 4 eta respecting an operator of a coal or other mine, antl assessin ent of a civil penally against an operator of a coal or oth er min0 antler 301J. S.C. 4 820(a 1.
<br /> An intliv itl ual woo, Oelnq sublet( to the F@Oeral Mine Safety antl Health Act of 19]] (30 U.S.C. 4 801 et, seq.) knowingly makes a false statement in any
<br />~, / report can be punishetl by a line of not more Than 510,000 or by im Anson men( for not more than 5 years, or both, under 30 U.S.C. 4 920(f (. Any intlwiUUal
<br />i who knowln gly antl willfully makes any false, Ilc[iti oui, or Irautlulenl Sla lemen ts, conceals a inat erial tact, or makes a fa lse, lictl (loos, or Irautlulenl entry,
<br />.!
<br />~ wdh respect to any matter wlthln the jurlstlictlon of any agency of the Unitetl States can be pumsh¢U by a brae ul not mo re than 510,000, or ImpnSOneU for
<br />~~ I not more than 5 years, or both, antler 18 U.S.C. 4 1001.
<br />' Important: This form must be completed and mailed wlthln 15 days after the end of each calendar quarter. MSI~A, Health and Safety Analysis Center
<br />`.~ 1. Fill out this form as completely as possible antl return the first sheet of this report to: ~ P.O. Box 25367
<br />r
<br />2. If it is necessary to make any address changes, indicate corrected information on this form.
<br />Denver, COIOra O
<br />
<br />~'~~ 3 Wlien preaddressed, this form is only for the operation with I.D. number as shown. ~
<br />Do not use for any other operation. S ~ '7
<br />D ~!? ~ ~ ~'~
<br />t._I 4. Sand and Gravel operators report employment data under code 03 or O6 as appropriate,
<br /> except for data on office workers which shoultl be reported under code 99. Date Report Completed
<br /> 5. All mine operators antl independent contractors reporting as required by 30 C.F.R., Part
<br /> 50, should show persons working and employee-hours worked, those producing coal show 5 I 9 I 90
<br /> also production tlata. Mrr. Day Yr
<br /> 6. Intlependen[ Contractors should complete quarterly only one form (or activities at all coal
<br /> locations,and one form for activities at all metal and nonmetal locations. Far Quarter
<br />1. Persons Working, Emplbyee~HOUrs, antl Coal Production ( First Quarter 1990 ~
<br />(11 Operation Sub Unir .. ~ Code
<br />~'~ ~
<br />Code/sl previous/y (?1 Average number olper- /31 Tora/ employee-hours (41 Production of clean pool
<br />a; 1-G Mail before
<br />reported: ~,~ sons working during quarter worked during the quarter during quarter, is/iorr tons/
<br />Underground
<br />Mine
<br />Underground O1
<br />Check here if this report is ^
<br /> being submitted by a contras or
<br /> Surface Shops, \ ~~~,V~ ~~~ ~\
<br />0Y ~~\ \ '~~ ~~~~~~, ~,
<br />V
<br />E
<br />~~
<br />'~
<br />~
<br />If Any Information Oelow Is Incorrect Please
<br /> ards,
<br />lc. ~ \
<br />~
<br />~ \
<br />' Enter Correct Information Here:
<br />Mine
<br />/including
<br />shops and
<br />yards/
<br />`~~
<br />~~
<br />Other Surface Mining
<br />(Metal/NOninetal Only)
<br />Dredge ~ O6
<br />Independent Shops or
<br />Yartls
<br />Iv1Jl Operations, Preparation Plant, or
<br />14ruakur IincludU assuri~tlcd shops and ymdsl
<br />Ollice (professional antl clerical workers al
<br />the mine or plant/
<br />2. Other
<br />Strap, Open Pit,
<br />or Quarry
<br />Auger (Coal Mine Onlyll 04
<br />Calm Bank or Refuse I 05
<br />Pile (Coal Mine Onlyl
<br />County
<br />Park
<br />Operation Name
<br />Alma Placer Mine
<br />Operating Company Name and Mailing Address
<br />Reclamation Resources, Inc.
<br />P.O. Box 986, 460 N. Main
<br />S~
<br />
<br />12 ~ \\~\\C,~\~\C~`
<br />~~-~ :480- \~:,° :`~.,;y<~~~.~ A7~ Colorado 80421
<br />\\~\~~~~~\C~~~` MSHA ID Number Contractor ID
<br />~, ~ y~\\~1~\~ \ 05-04927
<br />s
<br />99 \\
<br />~ I I~
<br />How many MSHA reportable injuries or illnesses did you have this quarter? ''~ None
<br />Person m Ue contacted
<br />regarding This report John P. Schmuck
<br />title
<br />Counsel
<br />(303)796-2626
<br />Form 70002. May 85 (Revised
<br />County
<br />Operation Name
<br />Operatng Company Name and Address
<br />Return to MSHA
<br />
|