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 ana Health A~ISlrahon (,(~ 'may/
Section 1-ViOldhon Uata
1 Date Mo
os De
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9 0 2 Time 124 Hr Clockl
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See Continuation Fo m IMSHA Form 7000-3a1 ^
9. Violation A. Health
Other p g, Section
of Act
~ _
~ C Part/Section of
Ttle 30 CFR
~
S a'
Section II-Inspector's Evaluation
10. Gravity: ~/'
A. Injury or Illness (hall list. No Lik elihootl^ Unlikely I]0 Reasonably Likely^ Highly Likely ^
Occurred ^
8. Injury or Illness could rea- i~
sonably be expected to be: No Lost Workdays^ Lost Workdays or Restricted Duty ^ Permanently
isabling^ Fatal
C. Significant and Substantial (See Reversel: Ves No ^ D Number of ersons Affected fJ
11. Negligence Icheck onel
A. None ^ B. Low ^ C Moderate ^ D. High ~
Reckless Disregard ^
72. Type o1 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/
prtler
Number F D fed Mo Da \'r

15. Area or
16 Termination Due
A Date Mo Da Vr B Time 124
Hr Clock) r
Section III-Termination Action
17 Action to Terminate

18. Terminated
A. Date Mo Da Vr
B. Time (24 Hr. Clockl
~.
Section IV-Automated System Data
19. Type of Inspection
(activity code)
O
O
~ 20. Event Number
D
3
3
4
/ 21 Primary or Mill
22 Signatur ~
r 23 AR umoer
MSHA Form 7000-3, Mar 85 (Revised) \ , I C