Document 3QqnnynjkwXV77kmdLk71XvBD

WllllMi: I i: I' l i! 11' l: - !'l!!l ; 11: l! : . 111 -11 -1 j i i 111111: -11 n = ........................11111 pi..............n 11 ri it1 : ..................mp........................ I I I ! I I I I 1 I I M ' I I I t.. I'1 I:: .................. mi- III' i 11 H ........................................... i;i i;.. .mi i. 1111111111111, .11 III':.. . 'II 11. ill . `I. .Ill -III -ill,.- Ill - ................I . : 111 i; . i 1111 11 .........................11 -i|n` 'I ':! ` ' I II . . ... AMBQEEN CHBIICAL PLANT--OOSMETRY RECORD Name Shift F:4- " Social Secur ity No. r^hnh^i Job Code Instrument No. Nobs Cell No. HAZARD \CM Lead Antimony Total Dust Noise Time Airflow 8AM\ yPyyUnw*caHCEurnajnoN a.s~ -* --Miorograms/Nn --Micrograms/M^ `-Miaograms/M,, --% PEL fi '--.-H .r> 1 1. L . ' Air Vol. (Liters) > _______ PEL: --Micrograms/M^ 1. IISdBA? Yes / No Analyst. Analysis Date ____________________ Hazard: VCM ( 1. I oame to work at 4. . :+, h - --1r mu. + 6. Other comments and information (Use reverse side of ejtrd) Signature 1:, VAB.0001067882