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+=~ ~ u'~ COLORADO DIVISION OF MINES <br />/ +-~~ <br />!rl. ~•~ '~~i . DEPg9TMENi OF NATURAL RESOURCES <br />•\~ 1319 Sherman Strset. Oenvar, Colvedo 80201 Telephone 892~1t01 <br />Norman R. Blake. Director <br />RICMARp O IAMM <br />• <br />GOr/eMOR <br />Coal Mine Inspection <br />OPERATOR'S MONTHLY REPORT <br />~ '7 <br />Fcr the month of . /~~~ Y 19? <br />.<cvan~.n ~ /7i..~•~ Address ~._ h,•..<<. <br />Paine ~ ' <br />..-.sic .CC>-[.•iv A:da..l~.( l9.r..~o GinP .•~+ C'.N..C . <br />;tames of: Superintendent ~/•~,~ ,~J7,- -:.-•--~ Mine <br />'JN J ~ ~ <br />Co:ipany lam.:. ^.: ~ ~ ..;.~ ~ii,...,i ~ ~r/.'r-' Address... <br />/_is.=+. fi ' County /' ~ ~ ~ <br />~~;. .~, <br />Foreman ~,ci- v ~~~= ~~.. . <br />7 <br /> <br />*ten Em to ed <br />u <br />Ma <br />-H <br />D I <br />l <br />T <br />t <br />Surface Gnderground Total n <br />o <br />rs <br />Worked ays <br />Worked o <br />a <br />Production <br />v z ~ 5' /D~o I ~/~ S/9/ I • ~ O i a9, /Sly <br />• All accidents of one day or more lost time must be reported. <br />;ate Name Cause of Accident Tine Lost Dtfe To Injury <br />u <br />-~y7 ~.~ <br />Signature <br />This Report Is Due In This Office By The 15th Of Each Month <br />C"? 5 (Rev. 12-76) <br />