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~, ~ 1. .. _,.. y,~.~.r.. vu~J Jl~.~~iii]I y• V.J. LwvrJYI II IICI I\ VI LQ ~ i/Ar \`/`~~ <br />Metal/Nonmetal Mlne Satety and Health A~nistratio •1_,(A•/~'J//1/V. `(`\i\ <br />Closeout ^ Change ^ Delete ^ Event umber 3 4 3 4 2 0 <br />O ` _ ~ ~ z ~ <br />Mine ID J <br />pV_ r <br />~'~~ COpY Lead AR umber <br /> 4R~~ <br />Offi <br />Code <br />~ ~ 4 Z <br />of Operator r ~ Name of Mine o~r Mill ~ ' <br />Type of Inspection/Investigation <br />O <br />(activity code) Part 50 Reporting V rifled t <br /> <br />Were Citations/Orders Issued, <br />Modified, ar Extended? q <br /> Month Day Year Mont ear <br />Day N <br />Inspection/Investigation Start Date ~ ~ 4 D Inspection/Investigation Stop Date D T <br />a 7 <br />L~LJ <br />Health Samples: <br /> Personal Exposure Area <br /> Number or Employees Num er of Samples <br />Respirable Dust <br />Isilira/nuisance) ~ Vacuum Bottles/Bistables <br /> <br />Total Dust <br />(silica/nuisance) IFFI~----7TT7TTTTI <br />I~ <br />Radon Daughters <br />Total Dust <br />ntal) <br />)elem ~ Fibers <br />e <br /> <br />Welding Fumes ~ Charcoal Tutees <br /> <br />Fibers ~ Detector Tubes <br />Noise Dosimeter ~ Sound Level Meter <br />Charcoal Tubes ~ Dust <br />Detettor Tubes ~ Wipe <br />Sound Level Meter ~ Other. N.E.C. <br />Other, N.E.C. <br />LL~~LL....~~JJ~~JJ <br />sentative Name <br />Miner's Re <br />pre Address <br />~~ <br />jj <br />N/~ <br />Telephone <br />N <br />umber )include Area Codel <br />~ <br />/ <br />~' v <br />Person Co ring Form 1n Date <br /> 1 n <br />I <br />~~ <br />MSHA Farm 40000.Oct 86 <br />T~ ~ I, ~ v <br />/`lyPV 1 UINC CII C <br />