Document OK4GkxodJvB81jGGxOao7G7j
ABD00325286
AfitSOEEN CHEMICAL PLANT-DOSIMETRY RECORD N 9 0 0 0 5 ^
Name
M. S>0/hU/d -Shift
J ?9'VLtmSoda) Security No. ^{ ~
Instrument Nn
- _____________Start Time O ^SaM( V^PM( )
*D*y
)PMJ^
Airflow.
HAZARD VCM
8AmssBBawsBfisoM Jsfrf-ma
Sample Time
Lead
--Micrograms/M^
PEL:
--Micrograms/M^
Total Dust
-Milligraim/M^
Analyscrl -*^y
ABD00325287
Hazard: VCM ( ) Lead ( ) Dust ( )
V I cfme'to work at
ijX'-- AM
PM { ) TM
2.1 left work at
( Q&o
AM ( )
Vfilin'3.1 did the regular work of a (enter Job Class)
4.1 used a respirator during the following jobs tcheck one)
None
Oust Mask
N
Work? Circle One)
000593 A
Alr*Une Rasp.
Scott AlrPak
IM 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'
iplete ai return to Guard