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Use Indelible PRESHIFT•MINE EXAMINER'S REPORT Report shall be <br />i <br />Pencil or Ink ~t/_~ Q/ ~l y y///y/~ signed when made <br />Date of Examination `___12,,~~~~__________________/__~___________ 19!_d Section ar Area Examined /. e~`~'_'~__"~~_____________ <br />Time of Examination: from J...9[C_a.m. or,~. toCC[f~_a.m. or .~fe! <br />Wan thin report phoned to autsiJe: Yes__.___ no_~~ <br />By whom _____________________________________________________________ Time __________A.M __________P.M. <br />I Report received by _____________________________________________________ <br />IaixnMl <br />~ Violations and other Hazardous Conditions 06eerved and Reported <br />I <br />Location __ _ Viofalion or azardoue Con ifion _ _ Action Taken <br />11~ 1.~~iCL~1_ ~,~L.QYL/__s~~E___________ ____________________ <br />2%~s~~,~~ ~~~~__,__I___~__ ________________________________________________ <br />4. ______________________________________ ________________________________________________ ___________________________________ <br />'~ 6. ______________________________________ ________________________________________________ ____________________________________ <br />I. 7. ______________________________________ <br />I ____-__-_____________________'_______________ ____________________________________ <br />r <br />"I 8. ______________________________________ ________________________________________________ ____________________________________ <br />~' 9. ______________________________________ ________________________________________________ ____________________________________ <br />iy <br />yi 30. ______________________________________ ________________________________________________ ____________________________________ <br />4 <br />i Air Meaeuremente <br />~;~ ~ Location CFA1 __-`-----------------Local-on -_-_---_ CFM <br />~~ ~l~!^y------------------------------ ~~i23__--- <br />~I i ---------------- --- <br />k, ~ --------------------------------------------- ----------------- <br />--------------------------------------------- ----------------- <br />Remarks: <br />This ie to eerti that (a) a section of the mine wen properly examined by me, (b) all violations of the Federal Coal Mine Health and Sa[ety <br />Act of 1969 a oche n aclory conditions and pr~cticesGob/se7rved by me ere listed in this report. <br />Signed HY ___ _ _____________________O_?Il_.~~_____________________________. ________________________ __________ ' <br />PrM, a Evminer CertlACxu No. Auimu Foremen Grtiacxu No. <br />m <br />Court ed ___ ___ _ ___ _____ __________ _____________________________.________________________ __________ I <br />Min nsen-Nme k'anm~n <br />_____________________ _ _____________________________ <br />Auuu nt Parem~n <br />//JUVerin4n~lenl nr AWrl~nl <br />