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

i•~Ii~V ~a Wi WiV v~JVI
Section I-Violation Data
• V.J. L/C~Jd1 UrlClll VI l 1 ~ ///~ //_`
Mine Safety and Health A minlsiratl {7(v/(`/_ (`(`"
1 Dare Mo
(//, ODZ
I
L Yr
~ 2 Time 124 Hr Clockl ~ / 0 3. Citation
Order
Number 3 6 3 U 8 2 9
Served To 5. for
6. Mine 7 Mine ID
Q
S
-
D
it
T
z
~
(Contractor)
g Con ~tion or Pra
ctice ga. Written Notice 11039) ^
d
G
O O 2

See Continuation Fbrm (MSHA Form 7000.3x1 ^
9. Violation A. Health
Othei ~ B. Settion
of Act _ C. Part/Section of
Title 30 CFR
S
~
~
3
Z
Section II-Inspector's Evaluation
10. Gravity:
A. In(ury or Illness (has) (is l' No Likelihootl^ Unlikely Reasonably Likely^ Highly Likely^
Occurred ^
B. Injury or Illness coultl rea-
sonably be expected to be: No Lost Workdays^ Lost Worktlays or Reslric[ed Duty^ Permanently
isabling^ Fatal
C. Significant and Substantial (See Reversel: Yes ^ No D Number o Persons Affetted O Q
11 . Negligence (check one)
A. None ^ B. Low ^ C. Moderate D. High ^ E Reckless Disregard ^
12. Type of Action 13. Type of Issuance (check one)
D - - ' Citation Ortler ^ Safeguard ^
14. Initial Action
D. Written
A. Gtation^ B. Order^ C. Safeguard ^ Notice ^ E. Citation/
Ortler
Number F. tetl

~ Mo Da Yr
15. Area or Equipment

16. Termination Due Mo
A Date p S Da
/ ! Vr
9 D g Time 124
Hr. Clockl
O
~
Q T
V
Section III-Termination Action
17. Action to Terminate

I
1
18. Terminated
A. Date Mo Da Vr
B Time 124 Hr. Clockl
Section IV-Automated System Data
19. Type of Inspection
(activity code)
D
O
/ 20. Event Number
3
I 21. Primary or Mill
22. Sig ~ 23 AR Number
L

MSHA Form J000-3, Mar 85 IRevisedl