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5800-FM-DMS0007 Rev.

7/2011

Commonwealth of Permsylvania
Department of Environmental Protectlon -PsrHr*E
Biturninous Mine Machine Operator Certificate
of Competency and Qualification

Certificate No. BM0-0084


*n","* &sh qa !3/4.ft )o.x-)o(.
of

who was bom in or,


"3'2C-/?fr
includins Zio Code)

(Place ofbirt (Date ofbffi)


appeared before me and salisfactorily demonstraled thal he/she is competent to handle and use an approved gas
detection device, is able to determine the presence or absence ofexplosive gas or other dangerous conditiors,
and he/she must also meet the eligibility criteria prescribed by the Department for certification as a mining
machine operator in the underground bituminous mines of Pennsylvania. This certificate is granted under the
Bituminous Coal Mine Safef Act on condition that the holder refrain from any violatiors of the Act,
Regulations, Approvals or Orders ofthe Departnent.

I hereby certify that the information provided


in my application is tntthfal and accurate within
0*fc r'.7s '&0t>
the best of my lotowledge.

(Social Security Number) Bituminous Inspection Distriet

THIS CERTTNICATE IS NOT TRANSFERABLE

5S00-FM-DMS0033 Rev. 7i201 1

Commonwealth of PennsYlvania
Deparhrent of Envlnonmental Protection
-P*mE
Bltuminous Miner's Certificale of Competency and Quqliffcation

Certificate Number BM-09470


^
\vhereas l"ry', &t', w.-w-- F6Z-
. A t- / Nc#r") 4- / - -nt ,/) $o;grycuriryNumber)

(Complete,zlddress, including le)


whowasbomin 5 on
(Place of Bi'nrh) (Date of Birth)
as that term is
appeared before me and satisfactorily demonstrated that he/she had one year ofexperience,
Coal Mine Safety Act This certificde entitles the holderto be employed as and to
deirned by the Bituminous
the work of a miner in the underground bituminous coal mhes in Pennsylvania- This certificate is
not
and an dtempt to transfer it shall be deemed a violation ofthe Act. This certificate is subject
to
transferrable
suspension or revocation for any violation ofthe Act, regrlations, approvals or orders ofthe Department

I hereby certify that the information provided


in ,ny application is trutttful and accurate within
the best of my latowledge.

r'/'1
(Social Security Number) Bituminous Inspection District

THIS CERTIFICATE IS NOT TRANSFERABTE

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