Document ByoaOLwnr2jgYJgbN1BJZZzBJ

U.S. Department of Labor Occupational Safety and Health Administration "ISIS Broadway New Y rk, New York 10036 Reply to the Attention of; TO:__________________________________________ _________ AREA OFFICE, OSHA REGION II SUBJECT: OSHA REGULATED CARCINOGENIC SUBSTANCES FROM: , FIRM NAME/ADDRESS_______________________ DATE THIS MEMO COMPLETED BY _______________________________________ TITLE' __________________ THIS FIRM (1) DOES____ (2) DOES NOT____MANUFACTURE, PROCESS, USE, STORE, REPACKAGE, RELEASE OR OTHERWISE HANDLE ONE OR MORE OF THE OSHA REGULATED CARCINOGENIC SUBSTANCES. IF (2) IS CHECXED, RETURN THIS MEMO WITH ABOVE INFORMATION ONLY. IF (1) IS CHECKED, ADD INFORMATION REQUESTED BELOW FOR EACH CARCINOGEN PRESENT IN YOUR ESTABLISHMENT(S) . N&me of Address where Regulated Substance is Substance (s)Present In-Plant How Substance Is Location of Utilized (see above Substancecategories)Location No. Employees at In-Plant UCC V0031*