Document 7RLmRjvbBD30OjyLXaLn7Geg

ABERDEEN CHEMICAL PLANT-MlllfliY RECORD pUft/T ifte'tTff/M <?//? Name----- ------- - . . ,, -- Shift '---------- ^pew -nwv/vo /w/*i gwrif/ty m N9 0993 A Dare /-/- Social Secur ity No.Job Code --~~~~~ 0Inctriimant Nn / Tima Start ft - 30 Stop ) 4-^ AM{ )Pfclf ) Airflow HAZARD VCM Lead Antimony Total Dust Noise Sample Tima Q'O C --Micrograms/M^ g --Miaograms/M --Milligrams/M^ --% PEL PEL: --Micrograms/M^ 115 dBA^ Yes / No /Ay Analvsf V A Hazard: VCM ( ) Lead ( ) Antimony ( ) Oust ( ) Noise ( ) J ) NS 1. I came to work atAM ( ) PM ( ) 2.1 left work atAM ( > PM ( ) Firewatch Work? Yes / No (Circle One) 3.1 did the regular work of a (enter Job Class)_______ 4.1 used a respirator during the following jobs (check one) Oust Mask Alr*Llna Rasp. Scott Alr-Pak 0953 * 3M Air Hat 5. The following unusual events may have caused me to be overexposed: 6. Other comments and information (Use reverse side of card) Signature______________________________________ Please complete and return to Guard