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 A~ISiratlon ~~ `~~/
i-V ioiation uaia
1 Date Mo
os Da
o z Vr
y a 2 Time 124 Hr Clockl
/
gs 3 Citation/
Order
Number
3630825
Served To ~!'"'~/~++"' /g~-w.}~V
~~ ~ ~~~ /(/J~ ~ ~ cif
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6. Min ~-7 5. erator r

7 Mine ID
Q ` z 7
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~

IContractorl
8 Condition or Practice Ba Written Notice 110391 ^

l

//~ I

See Continuation Fo m IMSHA Form 7000~3a1 ^
9. Violation A. Health
Salary ^
Other p g Section
o/ Act _ C. Part/Section of
Title 30 CFR O
p
2
LZ
Section II-Inspector's Evaluation
10. Gravity:
A. Injury or Illness (hall (isl: No Likelihood Unlikely^ Reasonably Likely^ Highly Likely^
Occurretl ^
B. Injury or Illness could rea-
sonably be expectetl to be. No Lost Workdays Lost Workdays or Restricted Duty^ Permanently
sabling^ Fatal ^
C. Significant and Substantial (See Reversel: Ves ^ Noll
'
~ D. Number of ersons Affected O
-
11 Negligence (check one) a
A. None ^ B. Low ^ C Moderate ~ D. High ^ E . Reckless Disregard ^
12. Type of Action
D
-
~
- 13. Type of Issuance (check one)
Citation Order^
Safeguard ^
14, Initial Action
D. Written
A. Citation^ B. Order^ C. Safeguard ^ Notice ~ E. Citation/
Order
Number F. Da ed Mo Da Vr
15. Area or Equipment

16. Termination Due
A Date Mo
Q „~ Da
~~ Vr
9 O B Time (24
Hr. Clockl
Q
Section 111-Termination Action
17. Action to Terminate

18. Terminated
A. Date Mo Da Yr
B. Time (24 Hr. Clockl
i
Section IV-Automated System Data
19 Type of Inspection
lactivit del
O
~
/
r 20. Event Number
Q
3
J 21. Primary or Miil
2 ur ~
~ 23 4R umber
MSHA Form 70003, Mar 85 IR 1