Form MS-04 "Technical Assistance Request Form" - Nevada

What Is Form MS-04?

This is a legal form that was released by the Nevada Department of Business and Industry - a government authority operating within Nevada. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on April 1, 2017;
  • The latest edition provided by the Nevada Department of Business and Industry;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form MS-04 by clicking the link below or browse more documents and templates provided by the Nevada Department of Business and Industry.

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Download Form MS-04 "Technical Assistance Request Form" - Nevada

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DEPARTMENT OF BUSINESS AND INDUSTRY/DIVISION OF INDUSTRIAL RELATIONS
MINE SAFETY AND TRAINING SECTION
400 West King Street, #210, Carson City, NV 89703
Phone (775) 684-7085
Fax (775) 687-8259
Email:
mines@business.nv.gov
Web Page:
http://dir.nv.gov/MSATS/Home/
Technical Assistance Request Form*
Date:
Mine Inspector:
County:
Company Name:
Mine Name:
Mine ID:
Email:
Contact Person:
Phone:
Fax:
Mine Inspection Request:
Regular Inspection
Courtesy Inspection
Last Inspection Date:
New Inspection
Ground Resistivity Request
Re-Grounding
Number of Groundings Needed:
Date of Last Ground Test:
New Grounding
Number of Groundings Needed:
Boiler/Pressure Vessel Inspection Request:
Pressure Vessel(s)
Number:
Date Last Inspected:
Boiler(s)
Number:
Date Last Inspected:
Industrial Hygiene Request for monitoring materials:
Dust/Silica Cassettes
Number:
Date Needed:
Metal Cassettes
Number:
Date Needed:
Other
Number:
Date Needed:
Industrial Hygiene Request for Survey:
Dust/Silica
Noise
Other (explain):
Industrial Hygiene Request for Information:
Status of monitoring results (Description):
Date Conducted:
Exposure/TLV Calculations:
Substance Information (Identify the Substance):
Monitoring/Analytical Methods:
Personal Protective Equipment Information:
Monitoring Equipment:
Other (noise, engineering, ventilation, etc.):
Request for Printed Material:
Note: Please mail, email or fax this request to our office (also maintain a copy for MSHA verification if needed)
Date Received:
Date Operation Contacted:
Date Completed:
MS-04 (REV 4/17)
DEPARTMENT OF BUSINESS AND INDUSTRY/DIVISION OF INDUSTRIAL RELATIONS
MINE SAFETY AND TRAINING SECTION
400 West King Street, #210, Carson City, NV 89703
Phone (775) 684-7085
Fax (775) 687-8259
Email:
mines@business.nv.gov
Web Page:
http://dir.nv.gov/MSATS/Home/
Technical Assistance Request Form*
Date:
Mine Inspector:
County:
Company Name:
Mine Name:
Mine ID:
Email:
Contact Person:
Phone:
Fax:
Mine Inspection Request:
Regular Inspection
Courtesy Inspection
Last Inspection Date:
New Inspection
Ground Resistivity Request
Re-Grounding
Number of Groundings Needed:
Date of Last Ground Test:
New Grounding
Number of Groundings Needed:
Boiler/Pressure Vessel Inspection Request:
Pressure Vessel(s)
Number:
Date Last Inspected:
Boiler(s)
Number:
Date Last Inspected:
Industrial Hygiene Request for monitoring materials:
Dust/Silica Cassettes
Number:
Date Needed:
Metal Cassettes
Number:
Date Needed:
Other
Number:
Date Needed:
Industrial Hygiene Request for Survey:
Dust/Silica
Noise
Other (explain):
Industrial Hygiene Request for Information:
Status of monitoring results (Description):
Date Conducted:
Exposure/TLV Calculations:
Substance Information (Identify the Substance):
Monitoring/Analytical Methods:
Personal Protective Equipment Information:
Monitoring Equipment:
Other (noise, engineering, ventilation, etc.):
Request for Printed Material:
Note: Please mail, email or fax this request to our office (also maintain a copy for MSHA verification if needed)
Date Received:
Date Operation Contacted:
Date Completed:
MS-04 (REV 4/17)