7000-51 Mine Operator Identification Request

Mine Operator Identification Request

U.S. Department of Labor
Mine Safety and Health Administration

Approved OMB No.: 1219-0042 / Expires: May 31, 2011

Mine Identification Number

Check Appropriate Box:

-

Metal/Nonmetal

Coal

Date: _____/_____/_____

Operating Company Name ____________________________________________________________________________________________________________
Mine/Plant Name __________________________________________________________________________________________________________________
Mailing Address For Document Delivery (Same as on Legal Identity Form) _______________________________________________________________________
City ____________________________________________________________________________ State __________ Zip Code _________________________
Contact Official ______________________________________ Title ____________________________ Phone (

)_______________________________

Nearest Town to Mine _____________________________________ State _________________ County ________________________________________
Status Date: _____/_____/_____

Office Code

Mine Type (Subunit):

County Code (FIPS)

(01) Underground

(06) Dredge

(03) Strip, Quarry, Pit, Dragline

(12) Other Mining

(04) Auger

(17) Independent Shops & Yards

(05) Culm Bank, Refuse Pile

(30) Prep Plant, Mill, Tipple

Metal/Nonmetal Mine Data
1

2

3

4

Status of Operation

SIC Code
F

I

N

Travel Area

P

Coal Mine Data

ADIB Use

A

B

C

D

E

F

G

Status of Operation

SIC Code

Work Group

AA AD CF CG BA CB AB
AC BD

CH BC
BE

BB

District/Field Office _________________________________________________________________________________________________________________

Name of MSHA Employee Requesting Number ___________________________________________________________________________________________

Office Telephone (

)_________________________________________ FAX Number (

)______________________________________________

FAX Verification
FAX Number: (303) 231-5515

Attn.

FAX Number:

Attn.

ADIB

MSHA Form 7000-51, (revised Feb. 11) This form is affected by the Privacy Act of 1974

Coder Number: _________________

Date: _____/_____/_____

Time: ______

Sender _________________

Date: _____/_____/_____

Time: ______

Sender _________________