Document 3eNyJ5ppd0Bde1Yz0Lke8K4X0

ALLEGED ORGANIC LEAD INTOXICATION (REPORT OF ATTENDING ETHYL CORPORATION PHYSICIAN) NAME OF PATIENT OPERATOR OF TANK J-f/fnj/jrS LOCATION OF TANK .)'/?- ir<f 4 NAME OF HOSPITAL LOCATION OF HOSPITAL r ; Ax T / /*. DOCTOR RESPONS IDLE FOR PATIENT Jfs tJ~f /, )/77j //J JOB STARTED (date) ____ X/y Zli JOB COMPLETED (date)_________________________ DATA TO BE CODED AGE J/# SEVERITY OF ILLNESS NO SYMPTOMS MILD ______________ MODERATE _____________ SEVERE ~ RECOVERED _ DIED ^ CONDITION OF EXPOSURE (Other Details in investigator's Report) NUMBER OF DAYS PATIENT ON JOB DATES WITHIN TANK /2^ ///-/? ESTIMATED TOTAL HOURS IN TANK days f hrs. WERE ALL REGULATIONS FOLLOWED YES NO WAS MASK WORN FULL TIME PART TIME NOT USED _________ yS' ANY EVIDENCE MASK INADEQUATE YES NO WAS SKIN OR CLOTHING WET WITH SLUDGE YES NO SUMMARY RELEVANT CONDITIONS OF EXPOSURE SYMPTOMS TIME ELAPSED CESSATION OF EXPOSURE - FIRST SYMPTOMdays (O = first symptom while still at work or less than 24 hours after exposure) CHARACTER FIRST SYMPTOMS_______________ __________ (Use symptoms number as below) ALL SYMPTOMS DURING ENTIRE ILLNESS (Please Check) *V! 7 Pwwrwctfektf M&U *&&{ <r&Zi /9 1. Weakness 2. "Nervous"^" 3. General Illness 4. Vertigo 5. Headache 6. Nausea-Vomiting 7. Anorexia i--- 8. Tremor 9. Apprehension-Fear 10. Insomnia/----- 11. Terrifying Dreams 12. Pallor 13. Constipation 14. Diarrhea 15. Belly Pain 16. Hypotension 17. Hyperactive Reflexes 18. Muscle Pain 19. Irrational 20. Disorientation1-""^ 21. Hallucination 22. Mania ESCAPE YES NO COMPLICATIONS YES NO CONTRIBUTING FACTORS YES NO DURATION OF ILLNESS (Days) ___________/ (From first symptom to recovery or death) days DATE SIGNATURE 0017082 iV, ha N - \ 55 ' 1 1 r li nr ST f 2? c v$ cs. ?\ K 0017083 >==f- | CONDITION PRESSURE OF PATIENT - 3- COURSE OF ILLNESS | BLOOD PB | URINE PB M G ./1 0 0 G . NAME CONDI DATE M r? b M>j mO m hj to !> O s sH, HO HH Hd o 55 w> O .>rj mi-4, 5> g H-* H H Bi Si-g3 ,!!! ^ H U M H M& ssgsfwCO H s* * a. O<b b t H ts H a o > K . S3 Ev Hi fr; w bd > so Hi mK H a td B S3 b M O > iH-U2 g \ b S3 W0 to1--i * S3 S3 a < 1 IS so raa HM*tov nd a hs3 gK S3 H otObr-a1 wCS3 t~ -O 0, 2 Oif) L zz f0 IU/S/ h r w? sifr&fd ^ <> /uu ^7] ^ fed &&< Mfr/dddl^ jdlfr jplfa/ t'u/d-d'' Su*i tdu* Ij'Jd I'/rf"" $f a r% *&*/* /&/ & i JfrU* />C lS~ /MPO^ / l&sttf t%srfrld fist pu*/. t/fi C / I'/^pd/udArda/'(/ {Urn, Im(pmd n-U^z-c &d frulytAd/^^ < Z/'^f S&t/ /I /y fr^bsfr*i. ii~.tA. '^ - sIrZSc^t. ^0* %' fifrfrv /uj&A& ' Z' iJ~~ %iiz/-;\0, /fryfrl^ foj-} /Lttysi //d dd^=> > /i . //-- bids;' -li*\*/u^'d.^d iA-1 id" MM/\. -`VPU'ts.Jj lAZ-t/iy j $u* .<jj id L{d^ frfrj ipj/fZ , f*>7o `/UJ. ^, szdj A*- lj^(^llld-i'Wt'd& /Sfri f.j '.K, pr/lu'-^--, ^J IW- JAJA fadt . /S' frutf pjfry/d ^ d-d / 7 0j^' Idls /1 fr/PU pAJP-i/ / 1&4H d IS ^ &*d lu did fdy/szsdth ^ r.j / J / ij /PJ ; d ~t& /1) /iAp/ 4udd(}~^j 'fcjTPf/'uy^ ifr-tpAJ^d TM d d d /J lAid dt) sfr4j ty/1^ Uf dd'A / ^Aup/lffr'yty/d f {h 4uad(- ~ U* jywAtt/u/dfrlt^-- % di/itj / )d/ Sud lyift /ddfrpy^^d, j) /l,A/'h^ /a a a dd 4 l-lttfrc-UA yitC(j/ ydlf ddtA ('PUL* uuudulz f/jfl\ d-Cfri/^^ .0017084 PATIENT NUMBER ,p ALLEGED ORGANIC LEAD INTOXICATION (REPORT OF ATTENDING ETHYL CORPORATION PHYSICIAN) NAME OF PATIENT OPERATOR OF TANK Jfan/jt/ /?j/& /1 LOCATION OF TANK Jf? /?/>/>/? NAME OF HOSPITAL LOCATION OF HOSPITAL^ DOCTOR RESPONSIBLE FOR PATIENT Jfy TT* h n I{ ~frG//7 JOB STARTED (date ) JOB COMPLETED (date) drj,- /a / 7 DATA TO BE CODED AGE SEVERITY OF ILLNESS NO SYMPTOMS MILD MODERATE SEVERE RECOVERED DIED CONDITION OF EXPOSURE (Other Details in Investigator's Report) NUMBER OF DAYS PATIENT ON JOB_ DATES WITHIN TANK Jxf /f f /$-- ESTIMATED TOTAL HOURS IN TANK days WERE ALL REGULATIONS FOLLOWED YES WAS MASK WORN FULL TIME PART TIME NOT USED _ _ z_ ANY EVIDENCE MASK INADEQUATE YES____ NO_ WAS SKIN OR CLOTHING WET WITH SLUDGE YES NO SUMMARY RELEVANT CONDITIONS OF EXPOSURE Kg' 00IT085 2- - JPATIENT NUMBER --^ SYMPTOMS TIME ELAPSED CESSATION OF EXPOSURE - FIRST SYMPTOM_ (0 = first symptom while still at work or less than 24 hours after exposure) Q days CHARACTER FIRST SYMPTOMS - V- f'^ (Use symptoms number as below) ALL SYMPTOMS DURING ENTIRE ILLNESS (Please Check) 1,, Weakness 2. "Nervous"1--^* 3. General Illness 4. Vertigo p--- 5. Headache/--- 6. Nausea-Vomiting ------7. Anorexia 8. Tremor 9. Apprehension-Fear Z---' 10. Insomnia 11. Terrifying Dreams 12. Pallor 13. Constipation 14. Diarrhea 15. Belly Paini-- 16. Hypotension 17. Hyperactive Reflexes 18. Muscle Paints 19. Irrational*-- 20. Disorientation 21. Hallucination 22. Mania;-- ESCAPE YES NO COMPLICATIONS YES_ CONTRIBUTING FACTORS YES NO NO y DURATION OF ILLNESS (Days) (From first symptom to recovery or death) 22- - days DATE 0017986 SIGNATURE XE 0017087 PATIENT NUMBER J ALLEGED ORGANIC LEAD INTOXICATION (REPORT OF ATTENDING ETHYL CORPORATION PHYSICIAN) :3 NAME OF PATIENT OPERATOR OF TANK LOCATION Of TANK [_ L^/) AxxA //fv / 1% /% A Ax NAME OF HOSPITAL /AxX / A/,__________________ LOCATION Of HOSPITAL A Xa /MX.-A DOCTOR RESPONSIBLE FOR PATIENT J}^ "TaA/7 /(' T~rX? J/7 ; JOB STARTED (date) j /! X a // -r ? ,< JOB COMPLETED (date)________________________ DATA TO BE CODED AGE SEVERITY OF ILLNESS NO SYMPTOMS_______ MILD ____ MODERATE SEVERE ______ RECOVERED ^ DIED CONDITION OF EXPOSURE (Other Details in Investigator's Report) DATES WITHIN TANK NUMBER OF DAYS PATIENT ON JOB days ESTIMATED TOTAL HOURS IN TANK ft' hrs. WERE ALL REGULATIONS FOLLOWED YES NO WAS MASK WORN FULL TIME PART TIME NOT USED _____________ ^ ANY EVIDENCE MASK INADEQUATE YES NO WAS SKIN OR CLOTHING WET WITH SLUDGE YES // NO SUMMARY RELEVANT CONDITIONS OF EXPOSURE , KfT 0017088 -2SYMPTOMS PATIENT NUMBER Vi TIME ELAPSED CESSATION OF EXPOSURE - FIRST SYMPTOM (0 = first symptom while still at work or less than 24 hours after exposure) CHARACTER FIRST SYMPTOMS______________ (Use symptoms number as below) ALL SYMPTOMS DURING ENTIRE ILLNESS (Please Check) 1. Weakness 2. "Nervous 3. General Illnessl-- 4. Vertigo ' 5. Headache *""" 6. Nausea-Vomiting 7. Anorexia*-"' 8. Tremor*-"" 9. Apprehension-Fear*"" 10. Insomnia*-"* 11. Terrifying Dreams*" 12. Pallor 13. Constipation 14. Diarrhea 15. Belly Pain*-"^ 16. Hypotension/--"'* 17. Hyperactive Reflexes 18. Muscle Pain*-" 19. Irrational Z*88" 20. Disorientation*-" 21. Hallucination 22. Mania ESCAPE YES COMPLICATIONS YES NO NO */ CONTRIBUTING FACTORS YES NO DURATION OF ILLNESS (Days) ___________________ days (From first symptom to recovery or death) days SIGNATURE 0017089 ^ _ 44^ ^017o$o -' PATIENT NUMBER_ ALLEGED ORGANIC LEAD INTOXICATION (REPORT OF ATTENDING ETHYL CORPORATION PHYSICIAN) NAME OF PATIENT_ OPERATOR OF TANK > ,//>/-*/ tPt.'iA. LOCATION OF TANK & M/)/?/; A NA-MMEE OF HOSPITAL f7 A/?? / / t/ LOCATION Of HOSPITAL / A DOCTOR RESPONSIBLE FOR PATIENT JOB STARTED (date) JOB COMPLETED (date)_ /L. //~yc d DATA TO BE CODED AGE 2_ SEVERITY OF ILLNESS NO SYMPTOMS_ MILD ~ MODERATE SEVERE " RECOVERED DIED CONDITION OF EXPOSURE (Other Details in Investigator's Report) DATES WITHIN TANK NUMBER OF DAYS PATIENT ON JOB_ /<f *-/? ( ESTIMATED TOTAL HOURS _I_N TANK ^__days hrs. WERE ALL REGULATIONS FOLLOWED YES____ NO WAS MASK WORN FULL TIME PART TIME NOT USED ANY EVIDENCE MASK INADEQUATE 1ZL YES NO WAS SKIN OR CLOTHING WET WITH SLUDGE YES NO SUMMARY RELEVANT CONDITIONS OF EXPOSURE 0017991 2- - PATIENT NUMBER -rJL SYMPTOMS TIME ELAPSED CESSATION OF EXPOSURE - FIRST SYMPTOM^ (O = first symptom while still at work or less than 24 hours after exposure) days CHARACTER FIRST SYMPTOMS (Use symptoms number as below) ALL SYMPTOMS DURING ENTIRE ILLNESS (Please Check) 1. Weakness 2. "Ne rvous General Illness Vertigo <--' Headache'-- Nausea-Vomiting Anorexia Tremor Apprehension-Fear Insomnia Terrifying Dreams Pallor Constipation 14. Diarrhea 15. Belly Paint-- 16. Hypotension 17. Hyperactive Reflexes 18. Muscle Pain 19. Irrational ,>---' 20. Disorientation *>' 21. Hallucination 22. Mania w--' ESCAPE YES NO COMPLICATIONS YES_ NO CONTRIBUTING FACTORS YES NO DURATION OF ILLNESS (Days) (From first symptom to recovery or death) JL_ days ! DATE !! SIGNATURE - K 0017092 ALLEGED ORGANIC LEAD INTOXICATION PORT OF ATTENDING ETHYL CORPORATION PHYSICIAN) NAME OF PATIENT OPERATOR OF TANK s/ ) LOCATION OF TANK A*_________ NAME OF HOSPITAL * t- / T LOCATION OF HOSPITAL />/?/& A DOCTOR RESPONSIBLE FOR PATIENT_ Jr ~%l,,fr77*/r, j ij : JOB STARTED (date) JOB COMPLETED (date) A/f; ,TY DATA TO BE CODED AGE ^ J~ SEVERITY OF ILLNESS NO SYMPTOMS MILD MODERATE SEVERE jdl RECOVERED DIED CONDITION OF EXPOSURE (Other Details in Investigator's Report) DATES WITHIN TANK NUMBER OF DAYS PATIENT ON JOB j f /<p / ESTIMATED TOTAL HOURS IN TANK ,, & days hrs. WERE ALL REGULATIONS FOLLOWED YES NO WAS MASK WORN FULL TIME PART TIME NOT USED ANY EVIDENCE MASK INADEQUATE 7^ YES NO WAS SKIN OR CLOTHING WET WITH SLUDGE /Q YES / ' NO SUMMARY RELEVANT CONDITIONS OF EXPOSURE aS-fuJ' , ZfA fays/ pi/^'ldy'lAr2yfffiofiA>y^ /V <4^1 0017094 r- r2 PATIENT NUMBER_ SYMPTOMS TIME ELAPSED CESSATION OF EXPOSURE - FIRST SYMPTOMdays (O = first symptom while still at work or less than 24 hours after exposure) CHARACTER FIRST SYMPTOMS__________________________ (Use symptoms number as below) ALL SYMPTOMS DURING ENTIRE ILLNESS (Please Check) 1 Weakness 2 "Nervous 3 General Illness iX 4 Vertigo 5 Headache' 6 Nausea-Vomiting 7 Anorexia ----- 8 Tremor 9 Apprehension-Fear 10 Insomnia 11 Terrifying Dreams 12 Pallor 13 Constipation 14 Diarrhea 15 Belly Pain!--" 16 Hypotension 17 Hyperactive Reflexes 18 Muscle Paini 19 Irrational 20 Disorientation1 21 Hallucination *- 22 Mania , &/-> /. ESCAPE YES NO COMPLICATIONS YES NO CONTRIBUTING FACTORS YES NO DURATION OF ILLNESS (Days) (From first symptom to recovery or death) days DATE SIGNATURE K 0017095 PATIENT NUMBER J -- ALLEGED ORGANIC LEAD INTOXICATION (REPORT OF ATTENDING ETHYL CORPORATION PHYSICIAN) NAME OF PATIENT OPERATOR OF TANK , /?// LOCATION; OF TANK ,Q} A ft# NAME OF HOSPITAL )/: LOCATION OF HOSPITAL , f% ^/> n/j /? DOCTOR RESPONSIBLE FOR PATIENT Jjr Js/y/? J( T7a if? JOB STARTED (date)__________ J JOB COMPLETED (date)______________________________ DATA TO BE CODED SEVERITY OF ILLNESS AGE NO SYMPTOMS_____ MILD ______ MODERATE SEVERE RECOVERED ^ DIED ______ CONDITION OF EXPOSURE (Other Details in Investigator's Report) DATES WITHIN TANK NUMBER OF DAYS PATIENT ON JOB yf 'f-/f ESTIMATED TOTAL HOURS IN TANK days hrs. WERE ALL REGULATIONS FOLLOWED YES NO^ WAS MASK WORN FULL TIME PART TIME NOT USED __________ ANY EVIDENCE MASK INADEQUATE YES____ NO WAS SKIN OR CLOTHING WET WITH SLUDGE YES NO SUMMARY RELEVANT CONDITIONS OF EXPOSURE 0017097 2 PATIENT NUMBER ,f~~ / SYMPTOMS TIME ELAPSED CESSATION OF EXPOSURE - FIRST SYMPTOM (O = first symptom while still at work or less than 24 hours after exposure) days CHARACTER FIRST SYMPTOMS (Use; symptoms number as below) ALL SYMPTOMS DURING ENTIRE ILLNESS (Please Check) 1,, Weakness 2. "Nervous" 3. General Illness 4. Vertigo 5. Headache 6. Nausea-Vomiting 7. Anorexia 8. Tremor/-- 9. Apprehension-Fear *^-"" 10. Insomnia 11. Terrifying Dreams 12. Pallor 13. Constipation 14. Diarrhea 15. Belly Pain**-- 16. Hypotension/-^ 17. Hyperactive Reflexest---- 18. Muscle Pain/----19. Irrational/-- 20. Disorientation 21. Hallucination 22. Mania DATE SIGNATURE K 0017098 PATIENT NUMBER ALLEGED ORGANIC LEAD INTOXICATION (REPORT OF ATTENDING ETHYL CORPORATION PHYSICIAN) NAME OF PATIENT OPERATOR OF TANK LOCATION OF TANK Z NAME OF HOSPITAL LOCATION OF HOSPITAL c _______________ / (//?/>Si /? _____________ DOCTOR RESPONSIBLE FOR PATIENT AfaA/7 K 77&S/1 JOB STARTED (date)__ JOB COMPLETED (date) DATA TO BE CODED AGE J> J SEVERITY OF ILLNESS NO SYMPTOMS MILD MODERATE SEVERE RECOVERED DIED z Z CONDITION OF EXPOSURE (Other Details in Investigator's Report) DATES WITHIN TANK NUMBER OF DAYS PATIENT ON JOB /J days ESTIMATED TOTAL HOURS IN TANK hrs. WERE ALL REGULATIONS FOLLOWED YES NO Z WAS MASK WORN FULL TIME PART TIME NOT USED z ANY EVIDENCE MASK INADEQUATE YES NO JJwLJ WAS SKIN OR CLOTHING WET WITH SLUDGE SUMMARY RELEVANT CONDITIONS OF EXPOSURE A YES NO Kf 0017100 DATE SYMPTOMS TIME ELAPSED CESSATION OF EXPOSURE - FIRST SYMPTOM O days (0 = first symptom while still at work or less than 24 hours after exposure) CHARACTER FIRST SYMPTOMS (Use symptoms number as below) _________ ALL SYMPTOMS DURING ENTIRE ILLNESS (Please Check) 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. Weakness "Nervous"/--- General Illness Vertigo i-- Headache -- Nausea-Vomi ting *-- Anorexia*---- Tremor Apprehension-Fear Insomnia Terrifying Dreamst--- Pallor Constipation Diarrhea Belly Pain Hypotension Hyperactive Reflexes Muscle Pain Irrational Disorientation Hallucination Mania ESCAPE YES NO COMPLICATIONS YES NO CONTRIBUTING FACTORS YES DURATION OF ILLNESS (Days) (From first symptom to recovery or death) NO *7 day SIGNATURE 0017101 N ce w 0ITS o. 3 55 55 (M4 0' a SI ro m i fe o WCO BS oO o a e2 < M Q HCO K< 3s^-i s O s S CHO Wo WQ 1 00 TJI . H 5 Wt-i EH 55 & wi-i fct 6-i O ss fr( o o Q 55 O No Kf 0017102 INCIDENT NUMBER TANK OWNED BY , ?fafr TANK HISTORY AND CONDITIONS OF EXPOSURE (Ethyl Corporation Representative Lay or Physician) <r// &/7 .{Jfy). TANK OPERATED BY LOCATION OF TANK sO /y ________________ AA ETHYL CORPORATION REGION A/'/'if? fa r? ETHYL CORPORATION DISTRICT TANK NUMBER/ ___________ __________ t71 / C& MEN EMPLOYED BY_//> g? ^J ^ f /X JOB SUPERyiSED BY________________________________________ SUPERVISOR EMPLOYED BY DATA TO BE CODED ATTENDED BY ETHYL CORPORATION REPRESENTATIVE FULL TIME PART TIME NO TANK CAPACITY_____________________________ TANK DIAMETER_____________________________ TANK TYPE__________________________________ LAST DATE PUT INTO LEADED GASOLINE SERVICE______________________ MONTHS SINCE LAST CLEANED.__________ LEAKING BOTTOM YES y NO WATER BOTTOM YES NO' TANK STEAMED PRIOR TO THIS ENTRY YES y/ NO TIME IN DAYS IDLE - FROM PUMP DOWN TO CLEANING HISTORY OF SPIKING YES NO MIXING DEVICE CIRCULATION PROPELLER JET OTHER APPROX. TEMPERATURE WHILE CLEANING HOT TEMPERATE NUMBER OF MEN INVOLVED NUMBER OF MEN WHO ENTERED TANK_____ NUMBER OF MEN SICK COLD JJZ -U- bbls ft. mo. days COUIOO ' GOf^lcJ} 2 ESTIMATED TIME ON JOB EACH MAN (HOURS) (Total work time both in and out of tank) INCIDENT NUMBERJ ESTIMATED TIME IN TANK EACH MAN (HOURS) (NAME) ll. J'-?-, .r-j. -=-L 4- 0017104 WAS MASK USED FULL TIME_______ PART TIME_______ NOT USED y WAS RESPIRATORY EQUIPMENT ADEQUATE YES WAS SKIN OR CLOTHING <) WET WITH SLUDGE YES V" , NO NO_ DATE 3 INCIDENT NUMBER J MCG. PB/CU.FT, AIR IF SAMPLE TAKEN TIME IN HOURS BETWEEN MEN QUITTING JOB AND AIR SAMPLE TAKEN VENTILATED DURING THIS INTERVAL YES NO SLUDGE SAMPLES TAKEN FROM INSIDE TANK YES NO SLUDGE SAMPLES TAKEN FROM OUTSIDE TANK YES NO INTERVAL IN HOURS BETWEEN MEN QUITTING JOB AND SLUDGE SAMPLE TAKEN CONCENTRATION ORGANIC PB IN SLUDGE ; ,(%) hrs. hrs. MEDICAL DEPARTMENT NOTIFIED - NUMBER OF DAYS AFTER FIRST ILLNESS __________ ^_________ days WHO IN MEDICAL DEPARTMENT DIRECTLY NOTIFIED / WS Signature - KE 0017105