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

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Mme Safety ano Hearth `Ilnlstratl n (/,l/~~~
Section I-Violation Data
1 Date Mo
os Dd
olz Vr
9o 2. Time 124 Hr CIUCk)
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~ i
o 3 Citation
~n"m~er
3630837
4~ServeU
Elf/ ~ 5.0 ror
6. Mine 7. ine ID
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S
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IContraclorl
d. Condition or Practice
8a. Written Notice 110381 ^
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' is Q. ~ ~y~
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See Continuation F rm (MSHA Form 70003x1 ^
9. Violation A Health
~,hef ~ B. Section
of Act
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5 _
~ C Part/Senion of
Tale 30 CFR
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Section 11-Inspector's Evaluation
10 Gravity:
A. Injury or Illness (has) list: No Likelihootl Unlikely ^ Reasonably Likely^~ Highly Likely ^
Occurred ^
B. Injury or Illness could rea-
sonably be expected to be: No Lost Workdays Lost Workdays or Restricted Duty ^ Permanently ,
isabling^ F a
C. Significant and Substantial (See Reversal: Yes ^ No D. Number o Persons Alfectetl D O L
11 . Negligence (check anal
A. None ^ 0. Low ^ C Moderate D. High ^
E Reckless Disregard ^
12. Type of Acton
Q
-
~
~
r~ 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 D tad Mo Da Yr
15. rea or Equipment
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16. Termination Due
A Date Mo Da Vr B. Time (24
Hr. Clock)
Section III-Termination Action
17. Action to Terminate

I
16. Terminated
A. Date Mo
I Da
I Vr
I
B. Time (24 Hr. Clock)
i

Section IV-Automated System Data
19. Type of Ins action 20. Event Number 21 Primary or Mill
P
(activity code) O ~ ~ 3 3 /
Form 70003. Mar 85
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