Quarry Production Report Form - West Virginia
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1STATE OF WEST VIRGINIA
’
,
OFFICE OF MINERS
HEALTH
SAFETY AND TRAINING
QUARRY PRODUCTION REPORT
04/2012
REVISED
MONTH:___________________YEAR:___________ WV PERMIT NO.:______________ COUNTY: _________________________
COMPANY NAME:_______________________________________________ QUARRY:___________________________________
ADDRESS:__________________________________________LOCATION OF QUARRY: __________________________________
MINERAL MINED:_______________________TYPE OF QUARRY: (
,
,
.)___________________________
UNDERGROUND
OPEN PIT
ETC
EMPLOYMENT
AVERAGE NUMBER OF EMPLOYEES AT WORK EACH DAY
-
_____________
__________
(
)
_________
NON
SUPERVISORY
SUPERVISORY
TOTAL
ALL
EMPLOYEES
___________
: __________________________________
NUMBER OF DAYS QUARRY OPERATED
TOTAL EMPLOYEE HOURS
PRODUCTION
DISTRIBUTION
THIS MONTH
YEAR TO DATE
THIS MONTH
YEAR TO DATE
S
AND
G
RAVEL
RAIL
S
G
AND AND
RAVEL
RIVER
S
ANDSTONE
TRUCK
L
IMESTONE
BELT
S
& L
AND
IMESTONE
USED LOCALLY
C
LAY
S
HALE
C
OAL
TOTAL TONNAGE
TOTAL TONNAGE
:
__________________________________________
MAIL COMPLETED REPORT TO
SIGNATURE
’
,
&
_______________________________________
OFFICE OF MINERS
HEALTH
SAFETY
TRAINING
PRINTED NAME
– S
P
C
D
______________________________________________
#7
2
LAYERS
LUB
RIVE
UITE
TITLE
C
, WV 25311-1626
______________________________________________
HARLESTON
DATE
# 304-558-1425
__________________________________
PHONE
TELEPHONE NUMBER
F
: 304-558-1282
AX
:______________________________________
WEBSITE:
EMAIL ADDRESS
04/2012
REVISED
Applicable laws and general instructional information.
Additional instructions and forms are available on our web site.
1. The operator of every mine shall, on or before the end of each month, file with the director of the West Virginia Office of Miners’ Health,
Safety & Training a report covering the preceding calendar month on the form(s) furnished by the director. Such reports shal l state the
number of accidents (Form 3333) which have occurred, the number of persons employed, the days worked and the actual tonnage mined, on
each permit issued by the Office of M.H.S. & T. (West Virginia Code Sections: 22A-2-77, 22A-6-4, and Administrative Regulations Series 3,
Section 52.01).
2. All mines and all “excess tonnage” prospecting operations (over 250 tons) are required to file these reports. If the mine is idle, tonnage
reports are required until such mine is permanently closed or bonding has been released. Failure to submit production report s will result in
the issuance of a notice of violation, and a resultant penalty.
3. General instructions: Print or type all information required. After completing this report, mail to the WV Office of M.H.S. & T., at the
address listed above. Additional instructions and forms are available on our web site at:
check for the link to forms.
Should you have any questions concerning the completion of this form, call or write our office (address and phone number shown above.).
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