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• v3 • I /~F <br />U. S. Department of Labor <br />Mine Safety and Health Administration <br />INSPECTION INFORMATION SHEET <br />Operation Address: Identification No.: ~ <br />r~~/ Inspection Date(s) <br />(y Inspection Code:~L~ <br />+^~~ D'Stz ~ [ ] Health Samples c <br />and sent to labo <br />analysis. <br />Type: (dustl (fiber <br />Telephone• ~ ~ <br />Company: <br />Mine Name: <br />City: 1 <br />Location: / /Nt.t, <br />83~ - Z 3 ~¢ <br />-.f . /) <br />~D44Z7 <br />for <br />(Specify) <br />County: <br />tate: <br />Type of Mine: Mining Method: Prod ct: <br />a40. Employees: Work Schedule: Hours/Shift Shifts/day Days/week- <br />Operating Officials: <br />__ ___. V V <br />Union Official & Address: D/(~A <br />INSPECTION PARTY <br />Company: <br /> <br />Union Rep(s): <br />Miner's Rep(s): <br />MSHA Inspector(s)~,/r~-~..A,O ~~ ~~~ <br />Other: <br />No. of Outstanding Citations: <br />~. of Outstanding Orders: <br /> <br />