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AFFIDAVIT OF MATTHEW CARROLL
STATE OF CALIFORNIA, COUNTY OF;
BEFORE ME, (he undersigned authority, on this day personally appeared, MATTHEW CARROLL, known to me or through his driver's license, and who, upon his oath, deposed and stales as follows;
My name is MATTHEW CARROLL I am over the age of eighteen (18) years, have never been convicted of a felony, and am fully competent to make this affidavit. The facts stated within.this affidavit are within ray-personal knowledge and-tre true and correct.
Attached to this affidavit as Exhibit MA`* arc produced under ray direction and control while 1 was^h^nadshili liygitnist working for She^h ., Oil Campaiiy-aiits .Wood.RivCT, IL refinery. These documents were made at or near the time of the tests reflected on them by a person with knowledge of such tests. The documents attached as Exhibit "A" were-made and kept in the ordinary course of Shell's business at the Wood River refinery by the Industrial Hygiene Department and it was the regular practice ofthe Industrial Hygiene Department to make and keep such tests. Each of these documents are genuine and authentic copies of originals made and kept by Shell in the ordinary course of their business.
And fuTthej' t)ie affiant sayeth not
MATTHEW CARROLL
Subscribed and sworn to before me. a notary public, in and for the State of
on this the tv-
day of
. 200T-to certify which witness my hand and offici
seal.
fNotary
KATHLEEN M. OLSEN k Commission # 1225&32 | Notcxy Public - California f
Santa Cruz County r MyComm. Expires Jut 20,2003 f
idtARY PUBLIC
My Commission expires:
. TONAL HYGIENE SAN.. UNO FORM
NAME
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PUPATION
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TIME
START TlMt /30|
CQ^l.
ATA. ,U. i.i.y. -
SEMI TO H.OJ
ihl no.
033220
SAMPLETYPE b 'FcOLLECTOnR V.' "-'fV ANALVSii AfauiHio
1 PERSONAL-TWA 2 OflfftSONAL-rEAK 3 0 AREA 4 0 BLANK 5 O BULK . SDLAB CONTROL $ 0 SOURCE
1 CHARCOAL TUBE
2 FILTER (RISP.) 3 BTTlTIR (TOTAL)
4 a IMPINGE A
,n PASSIVE 9 aDOSIMETER 9 OSILICACEL
7 0 PACKED TUBE
10
CODE
NAME
`reorof A^/n4jLL*i *
" RESULT 2?.*/
y UNIT 10PPMV IOMG 2Q?J0/VS 6 0PIBER 3 0PPBV 7 OX WT 4WffM/0 X VOL.
* 90-----------------OATE SAMPLED
P0SSI8tfe INTERFERENCES/INSTRUCTIONS
SHIFT o
a
Barometer WIND
TEMPERATURE
IN. HO HUMIDITY
CjQ.rr\<LQX^n^S'- 3
ms.
DESCRIPTION OP COLLICTOA UPO. LOT NO. ETC.I AITUftW RESULTS TO'""
M.P.H.
X R.H. S^yc^n.'O.S'Jj ma-g dvffV 7rt (uQo^JteiL
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WORK TASK
TIME
;INSTR.
'PPE AT TASK READING
SKETCH AREA (And Or Rtmtrkt)
A-l^man-r</i. ._~j_/Urvv
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instrument Type a model no.
^______________ j_
CALI8RATE0 6Y
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REFERENCI/METHOO
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volume per Count
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COUNTER READING
^ INFORMATION FOR TWA DETERMINATION
LENGTH OP IHIPT I V SO | MIN.
DOES THIS SAMPLE REPRESENT EXPOSURE
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DYES
H No:
Bffo
INCLUOI RESULT* PROM____ .AOOITIONAL SAMPLES lATTACMEOI
ASSlON ZERO ixposure POR _____ MINUTES OP SHIPT OURINO TtJlOO NOT SAMPLE0,
OrfwA CANNOT BE CALCULATED FROM THESE SAMPLES.
y COMMENTS
plSwTTaTI a. I
sampling time
f AV MIN.
sv.y
PINALINITIALNET.
WAS A RESPIRATOR WORN DURING SAMPLE TO CONTROL EXPOSURE?
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NAME
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UNIT QPPWV 5 QUO 7 0MGAO t0 FIIER 3 OP^IV 7QRWT 4(3%?inl OR VOL.
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TYPEi GIVE EQUIPMENT USED, MFR, MODEL NO, ETC.
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LLENGTH OP SHIFT
JUlN.
DOES THIS CAMPLE RtfRESENT EXPOSURE
OVER THE ENTIRE SHIFT!
DYES
It hoi
ONO'
IKCLUM RUUVT* PNOM______AOWTK*<ALAMnjl lATTAOztDI
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ptAtaoMor*AUPtco.
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O TWA CANNOT IE CALCULATED FROM THESE SAMPLES.
. FLOWRAtl *3.0 JLp------
SAMPLING TIUE I y 0*5" uiN.j
FINALINITIAL* i_ NET.
WAS A RESPIRATOR WORN DORfHO nyM SAMPLE TO CONTROL EXPOSURE? UTt5 UKa
OIO ANY SIGNIFICANT SKIN CONTACT OCCUR?
DYES ONO
y COMMENTS
1 rrW.
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CLARIFICATION y (S. /
CtJLglFirinV------------------------CTTT
CAA4M.CO rY (LAST HAMC Jk INITIALS]
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----- -------------------------------------- " .
GROUT
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"ANALYTICAL RESULTS
NUMBER Of ANALYSIS
2
' ..'1
l
OATH RETORTED
A(WEEK--- DAY)
BENCH HOURS
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'4PLING FORM
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. -TIME <*t JfAAT TIMt 1*1-3
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[S0JTTOH.O.I >hu no.
H&wniTffEgf (ffrcotmECTpF^ PSy-T JWALHWEUH IRED' K
1 O PERSONAL-TWA 1 CHARCOAL tune CODE
NAME
RESULT
JO PERSONAL-PEAK
3B<nCA
4 BLANK
SOBULK C OLAi CONTROL
a DFILTER tRESP.J
a bFilteii (TOTAU
4 IMPIMGER .-PASSIVE
DOSIMETER OSTUCA CEL
ei*ar>i CLaXkZCry ..
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} SOURCE
8
7 OPAOCEDTUBE n--------------------------
POiSIQLS t^ERfERENCES/l(l"slRLcYl(ii"
V UNIT
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V o^/^oI&jT SHIFT ^ GT''' &
BAROMETER-
ttMPtftAfURE
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ytT\ B.
I'r 'TIME , irtrm. ' PfE AT TASK READING
(' SKETCH;/UJEA.fA*# Or RwnwtaJ
nuiU .-to'Y rv^KiUi i
* PUIKTm DEPOSITION
etkebit
i U. frZhM
`Perron*! Proitchre Equipment: Check Column for Etch Tttk tYherw Worn
TYPE: GIVE EQUIPMENT USED. MFfi., MODEL NO.. ETC.
INSTRUMENT TYPE h MQOELN0.
imrcM.--------- .. INFORMATION-FORsTWA'OETSRMtNATtON -i-.
fTNSA-
CALIBRATED IV
,rQa^. AEPEflENCE/ut THOD
t
o loqC\
3STE
'
O^/zxoJ IS"
LENGTH OF SHIFT L
Jmin.
DOES THIS SAMPLE REPRESENT EXPOSURE
OVER THE ENTIRE SIIIFT7
D YES
// AM:
ONO
y COMMENTS
VOLUME PER COUNT
>'lOw A Alt ' 3.0
SAMPLING TtUE V 20 MIH.
'
COUNTER READING ~ FINAL*
INITIAL*
L NET-
PtRlOO HOT UMPUO. 0 TWA CANNOT DE CALCULATED FROM THESE SAMPLES.
Vf
Y/AS A RESPIRATOR WORN OURING SAMPLE TO CONTROL EXPOSURE!
nvr< UTt5
nwA UHO
Vr
DIO ANY 90NIFICANT SKIN CONTACTOCCUtW
OYM n NO
UTM DN0
pd
.
CLASSIFICATION y @ @
dLAiiiFIlfiV
tnpCbHHM
REVIEWED BY
SITE
*lnlur
DATE