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 Safely and Health ~linistratlt3~1 v ~ ~`~
ion
1 Date Mo
0 `
/ Da
0 2 Vi
p /t
/ C! 2 Time 124 Hr Clockl
/ O Z O 3. Citnnon
Order
Number 3 6 3 0 8 2 3
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t Ba. Written Notice 110381 ^
7000 - '

MSN,4

/989 ao ~ S / 90

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See Continuation F rm IMSHA Form 70003x1 ^
9. Violation A. Health
Other ~ B. Secton
of Act
~
O
3 _ C Part/Senion of
Title 30 CFR
~
~
3
Section II-Inspector's Evaluation
10 Gravity:
A. Injury or Illness Ihasl lisl No Likelihood Unlikely ^ Reasonably Likely^ Highly Likely ^
Occurred ^
B. Injury or Illness coultl rea-
sonably be expected to be: No Lost WorkdaVS Lost Workdays or Restricted Duty ^ Permanently
Disabling^ Fatal ^
C. Significant and Substantial ISee Reverser Yes ^ No D. Number o Persons Affected O Q
11. Negligence Icheck one)
A. None ^ B. Low ^ C. Moderate D. High ^
E Reckless Disregard ^
12. Type of Action
/
Q
-
' 13. Type of Issuance Icheck one)
Citation ~ Order^
Safeguard ^
14, Initial Action E. Citation/
D Written Order
A. Citation ^ B. Order ^ C. Safeguard ^ Notice ^ Number F. atetl Mo Da Vr
15. Area or Equipment

16. Termination Oue
A. pate Mo
o C
JJ Da
/ / Yr
9 D 8. Time (24
Hr. Clock)
Section III-Termination Action
17 Action to Terminate

18. Terminated
A. Date Mo Da Yr
B. Time 124 Hr. Clockl
Section I V-Automated System Data
19 Type of Inspettion
lactivity code)
D
O
/ 20. Event Number
Q
3
4
'~ / 21. Primary or Mill
22 Si A 23 AR Number

MSHA orm 70003, Mar 85 (Ravi )