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 Salety and Health ~Inlsiratlc~n ~'"L '~`~
Section I-Violation Data
1. Date OMO
S Da
O 2 Vr 2 Time 124 Hr Clock I
9 OI

- - /

-
~

-

-

-

_
- 3 Gtmion
Order
Number 3 6 3 0 8 2 8
erved T
~
1 5. O a or
i
6. Mine 7. Mine ID
-
O
~1
7
L
7
IContractorl
B. Con nor Practice Ba. ~t~en No[ice 110391 ^
98~

~ - ,.,J

See Continuation F rm IMSHA Form 70003x) ^
9. Violation A. Health
Other ~ g. Section
of Act _ C. Part/Section of
Tiile 30 CFR
~
~
/
4
/
Section II-Inspector's Evaluation
10. Gravity:
A. Injury or Illness (hasl (is)' No Likelihood^ Unlikely Reasonably Likely^ Highly Likely ^
Occurred ^
B. Injury or Illness could rea-
sonably be eKpectetl to be: No Lost Wurktlavs^ Lost Workdays or Restricted Duty^ Permanently
~sabling^ Fatal
C. Significant and Substantial (See Reversal: Yes ^ No~ D Number o Persons Affected O O
11 Negligence Icheck one)
A. None ^ B. Low ^ C Moderate D. High ^
E. Reckless Disregard ^
72. Tyce of Action
/
~
¢
~ 13. Type of Issuance Icheck onel
Citation Order ^
Safeguard ^
14. Initial Action
D. Written
A. Citation ^ g. Ortler ^ C. Safeguard ^ Notice ^ E. Citation/
Order

Number F tad Mo Da Vr
15. Area or Equipment

16. Termination Due
A Date Mo
O Da
~ J~
V Vr
~ D B Time (24
Hr. CIOCkI
O
8
a
Section 111-Termination Action
17. Action to Terminate

18. Terminated
A. Date Mo Da Yr
8. Time (24 Hr. Clock)
Section I V -Automated System Data
19. Type of Inspection
(activity c e)
O
/ 20. Event Number
p
3
/ 21 Primary or Mill
Z2. Sig ~) 23 AR umber
MJHA Form /UUU~J, Mar ab IHevK¢Q)