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REPORT OF ANALYSIS
REFERENCE NO.
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CONFTOFN T T At.
INDUSTRIAL HYGIENE SAMPLE CUNCEN1RAT ION DAI A E1URY
NAME OF INVESTIGATOR:
CHEMICAL NAME
REnzfue
PLANT
ihc m
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4?
SAMPLE DA VE V I'lMUDYY .1 SAMPLE NUMBER SAMPLING TIME IN MIN.
SAMPLE VOLUME IN LITERS SAMPLE TYPE CA,S OR P >
A--AREA S--SHORT TERM
P-PERSONAL IF AREA, DESCRIBE RESPIRATOR TYPE <. 1 TO 7uT
8 OR 12 HOUR SHIFT SHIFT 1 . 2, UR 3
EMPLUYEE l .0. NO .
IH JOB ASSIGNMENT 11
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SAMPLE CUNCLN 1 RA V I UN RESULT__________ &lL-PHO-
COMMENT SA]Y}JL^&JLQJr,
^RESPIRATOR TYPE: 4 = FULL FACE
NOT USED 5 = AIR LINE
RAW DATA:
START TIME:
STOP TIME:
S^
BEGINNING FLUW KATE:
ENDING FLOW RATE:
MUUlH-blT
J = HALF FACE
S = DUST MAST.
7 = SC BA
INDUSTRIAL HYGIENE SAMPLE CUNCEin RAT ION DAI A ENTRY
NAME [' INVESTIGATOR: ^QsjL-^UiZl&L
PLANT
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RESPIRATOR TYPE U TO J,) *.
Q GR 12 HOUR SHIFT SHIFT 1 , 2. UR 3 EMPLOYEE I.D. NG . IH JOB ASSIGNMENT 0
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SAMPLE CUNCEN l RA F I UN RESULT
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COMMENT SAJY)Ll-3JiDJr_
f.RESPIRATOPv TYPE: 4 = FULL FACE
NOT USED 5 = AIR LIME
RAW DATA:
START TIME: STOP TIME: ^
BEGINNING FLOW RATE: ENDING FLOW RATE:
MUUIH-BIT
3 = HALF FACE
= DUST MASK
7 = SCCA
0 I J A \ 'I f": ( 1 , ' 1
CONF T Df," N'T T Ai
INDUSTRIAL HYGIENE SAMPLE CUNCENIRAT ION DAlA E1URY
NAME OF INVEST I GAtDR:___ ______________________________
CHEMICAL NAME ____ fiEJiA^JUzdr
PLANT
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PLANT NO .
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SAMPLE DATE iMMDUYY.i SAMPLE NUMBER SAMPLING TIME IN MIN. SAMPLE VOLUME IN LITERS SAMPLE TYPE A, S UR P?
A=AREA S=SHORT TERM P = F'ERSUNAL IP AREA, DESCRIBE
RESPIRATOR TYPE !l TO J,) T
8 OR 12 HOUR SHIFT SHIFT 1, 2, UR 3 EMPLOYEE I.D. NO. IH DOB ASSIGNMENT 0
__ jzq" // 360
____________
_____ r__ _ _ _ _ _ _ _ _ _ _
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SAMPLE CUNCENIRAI IUN RESULT____________
COMMENT:; SAlLl-3ADJz.
TRESPIRATQR TYPE: 1 = NOT USED
4 = PULL PACE
5 = AIR LINE
RAW DATA:
START TIME:
STOP TIME:
S^
BEGINNING FLOW RATE:
ENDING FLOW RATE*.
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3 = HALF FACE
6 = OUST MAST.
7 = SCBA
DO COUTI1
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INDUSTRIAL HYGIENE SAMPLE CONCENTRATION DATA ENTRY
NAME QFr INVESTIGATOR:____ Y_ J3US/jJ______________ CHEMICAL NAME____ J+JL-UldTA &!![.}]?______ DRU____ QOOJL-0_(oOO_
PLANT_________ ABAJEi'______________ PLANT NO.
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SAMPLE DATE UTMUDYY.) SAMPLE NUMBER SAMPLING TIME IN MIN. SAMPLE VOLUME IN LITERS SAMPLE TYPE (A,S OR P)
A=AREA S--SHORT TERM P=PERSONAL IP AI\EA, OESCRICE
RESPIRATOR TYPE O TO J,)X
8 OR 12 HOUR SHIFT SHIFT 1, 2, UR 3 EMPLOYEE I.D. NO. IH JOB ASSIGNMENT 41
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SAMPLE CONCENIRATIUN RESULT _________ azapj>-
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A = FULL FACE
5 = AIR LINE
11AW DATA:
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START TIME: ~
STOP TIME:
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ENDING FLOW RATE:
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3 = HALF FACE
b = OUST IT ASP-
7 = SOLA
'l l.A"
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INDUSTRIAL HYGIENE SAMPLE CONCENTRATION DATA ENTRY
NAME OF INVESTIGATOR:____ SAC JsUjJjjJ CHEMICAL NAME____ _)jj TJ\ DjJLhUiL___________ DRU
PLANT_________ ______________________ 'PLANT NO.
Q00JL~_0 kO______
____
SAMPLE DATE i. ITMUDYY !> SAMPLE NUMBER SAMPLING TIME IN MIN. SAMPLE VOLUME IN LITERS SAMPLE TYPE CA,S OR P>
A=AREA S=SHORT TERM P=PERSUNAL IF AREA, DESCRLEE
RESPIRATOR TYPE (.1 TO 7,)
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SAMPLE CGNCEN1RATION RESULT
4-e-*r
_____ I _____________________
_____ J3JL&_____
_______ P_____________
_ _ _ _ _ _ ft__________ _____ L__________ _______ U_ _ _ _ _ _ _ _ _ _
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2 = MUUIH-BIT
3 = HALF FACE
4 FULL FACE
5 = AIR LINE
G OUST NASK
7 = SCBA
RAW DATA:
START TIME: <?^
STOP TIME:
3
BEGINNING FLOW RATE:
ENDING FLOW RATE:
'
lx* A i 1 n i : s ' M
confiorNTT Al
INDUSTRIAL HYGIENE SAMPLE CONCENTRATION DATA ENTRY
NAME OF INVESTIGATOR:
CHEMICAL NAME .MA.BiAlhPJIXk._____ drw^oqpjL'O^oq.
PLANT
JLjJSz-Sr.
PLANT NO.
4?
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A=AREA S--SHORT TERM
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RESPIRATOR TYPE U TO J,) *.
6 OR 12 HOUR SHIFT
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~_______ ______ ___ _~I I _______ 3__
"_ $ _I_~_ f_
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SAMPLE CONCENTRATION RESULT_______ QL,JZLiC________
comments :
'.'.RESPIRATOR TYPE: 1 = NOT USED
2 = MUU1H-BIT
3 = HALF FACE
4 = FULL FACE
S = AIR LINE
= OUST MAST,
7 = SCBA
RAW DATA:
START TIME:
STOF TIME:
33^-
BEGINNING FLOW RATE
ENDING FLOW RATE: