Document YDjbbGz4rEg1n3zbG5z29aqbN
FILE NAME Brakes BRK
DATE 1986
DOC BRK099
DOCUMENT DESCRIPTION Journal Article - Asbestos Dust Exposure During Brake Repair same as 97
s
000422
silica cause lung
! Med 285-294
genkrebsh^/ufigkeit
on Health 218-9 Suppl
American Journal of Industrial Medicine 10 63 712986
;
Asbestos Dust Exposure During Brake Repair
K. R^delspergerPhD H. Jahn ING B. Br^...ckelING J. Manke
R. Paur MD and H.-J. Woltowitz Prof Dr Med
PhD
About 10,000 tons of chrysotile per year are used in the Federal
for
production of friction
Republic of Germany
the brake materials During
repair an unknown number of
By copy and by scanning transmission electron microscopy electron
tremely
fine chrysotile
fibers with
lengths
<
5
microscopy ex
...mwere identified in brake drum duit
Fibers with lengths > 5 ...mconstituted less than % of all
4
brake drum dust Short asbestos dust
chrysotile fibers counted in~fl
in
101
personal
samples
during
blowing
exposures were measured
out of brakes and
by
light microscopy
linings During blowing out of car brakes as well
grinding and turning of brake
the product of fiber concentration with
as during grinding of brake linings
about 4-5 fibers + min
length > 5 ...mand sampling time amounted to
min For trucks and buses corresponding to a concentration of 106 fibers over 4-5
.
higher amounts of 5-10 106 fibers min were observed
during these operations From occupational histories of 210 vehicle
average duration of employment of x is is = 21 -10
and
mechanics an
dose of x -s = 0.54 -1.1 106 fibers
years
a mean cumulative fiber
years were calculated
Key words brake repair auto mechanic asbestos
occupational history fiber dose
exposure light and electron microscopy
INTRODUCTION
communication The amount of brake lining material used during 1975 in the Federal
of Germany
was estimated
to
be
26,000
tons
Ullman
et al
1978
Republic
The asbestos
content of brakes used in the FRG ranges from 10-70 weight- with an
of
35
weight-
Infrared
spectographic
analysis
of
18
samples
of brake
average material
in the following reading of chrysotile Jahn et al 1985 x - = 30
resulted
| In accordance with these data it would appear that the asbsestos con-t1e1ntweofigbhratk-e
}
material increased from 9,000 year in 1975 to about 12,000 year in 1980 and
dropped to 10,000 year in 1983 G Schmidt 1984 personal
Institute and Polyclinic for Occupational and Social Medicine
eral Republic of Germany
University Giessen Fed-
Address reprint requests to Dr. K. R^delspergerInstitute and
Medicine of the University of Giessen Aulweg 129 6300 Polyclinic for Occupational and Social
Accepted for publication February 18 1986
Giessen Federal Republic of Germany
'1986 Alan R. Liss Inc.
EXHIBIT NO
Betty Brownino
:
4
t
iy
64
R^delspergeret al
{
!
i
A large percentage of the approximately 300,000 car mechanics in the F.R.G. . have been exposed to asbestos dust during the cleaning of brake systems and the
machining of brake linings It is the aim of this study to estimate the exposure to asbestos dust for this large group of persons
Similar to earlier studies on the use of products containing asbestos Heidermanns et al 1978 R^delspergeret al 1980 Woitowitz and R^delsperger1983 a
risk assessment is made on the basis of ) dust measurements during brake service
2 screening for fibrogenic reactions by chest rays and 3 evaluation of standardized work histories Our intent is to examine a group of about 400 vehicle mechanics
to date 210 have been examined
MATERIALS AND METHODS
During the maintenance of automobile brake systems 90 dust measurements in 76 garages were taken with static and personal samples In general personal sampling was extended over the whole service operation which lasted 1 h or more but in some cases personal sampling was limited to certain generating work operations Therefore depending on the duration of the work operation sampling time varied
from less than 3 min to more than 1 h
Fiber concentrations were determined by light and electron microscopy Fibers with lengths > 5 ...mwere counted with phase contrast light microscopy using the reference method of the AIA Asbestos International Association 1979 In addition counts of fibers of lengths 5 5...mand fibers of all lengths were made by scanning transmission electron microscopy at magnifications of 6,300 and 29,000 Since it is suspected that the mineral structure of fibers is altered during the braking process all fibers were examined by energy dispersive ray analysis and electron diffraction
In addition to the dust measurements an epidemiological sectional study was planned for a group of 400 car mechanics who have been involved in brake maintenance for at least 10 years A standardized occupational history was adminis-
tered to each individual and an extended medical examination made To date 210
occupational histories describing 459 different sets of working conditions under which
brake maintenance is carried out have been evaluated
RESULTS
Working Operations
The number of working operations which were registered in 76 automobile garages during dust sampling can be seen in Table I.The use of exhaust ventilation is
also indicated
Compressed air was used to blow out loose dust in 15 of 36 garages servicing cars and in 19 of 40 garages servicing trucks or buses Special exhaust ventilation systems were used during blowing operations in 8 of the car garages and in 10 of the bus and truck garages In addition to compressed air blowing brushing and the use of solvents were observed Only brake systems heavily contaminated with oil and
dirt were cleaned with hot water
Fitting of new brake linings for cars was done with special grinding machines in 20 garages Although each grinding machine was combined with an exhaust ventilation none of the filter bags were suitable for asbestos except in 3 garages
[- -
Ent
Ind
ce
*
iss
ie
rn
[Or
ee
ee
mee
8
ms as
ee Ot
BRO
MOS
Cre
Re
ee
~~
ee
ae
1
4
GE Y > TES
| ||
L
|
>
ESES
ee|
Asbestos Dust Exposure During Brake Repair
65
TABLE I. The Number of Work Operations Releasing Dust Observed During Brake Repair in 76 Automobile Maintenance Shops
Operation
Passenger
car
n = 36
Blowing out dust Machine grinding of
drum brake linings Turning of drum
brake linings
15 8
20 20
_
With exhaust ventilation
For 17 of these systems the filter bag was not suitable for asbestos
Truck bus
n = 40 19 10
4
34 11
TABLE II Concentrations of Fibers With Lengths > 5 ...mDetermined by Phase Contrast Microscopy
Brake service in automobile repair shops Fiber concentration -10 -10 fibres
Passenger
;
Truck
car
bus
Operation
= 31
n = 36
Blowing out Dry brushing Riveting off and on Grinding by hand Machine grinding
Turning Combinations
4
0.10
4
0.05
4
0.09
1
0.15
7
0.10
7
0.12
_
-
5
0.06
1
0.39
-
_
18
0.08
11
0.04
S
0.08
Phase contrast microscopy of fibers with length > 5 ...mPersonal sampling for > 30 min seven measurements were made of personal air samples taken during brake service deviations approximately equal mean values
Standard
Grinding of brake linings was only done in 4 out of 40 garages servicing trucks and in one of these with exhaust ventilation Thirty garages used a turning machine for fitting brake linings In addition to the stationary machine special movable
equipment with arotating cutting tool was used which could be mounted to the axle
of the truck Exhaust ventilation was also available for the turning machine in 11
garages servicing trucks In general blowing out and grinding only take a few min
for each vehicle On the average the turning of brake linings takes about 30 min per
vehicle
Concentration of Asbestos Fibers
Light microscopy Table II shows the results of 67 measurements of fiber concentrations during personal air sampling of brake repair work for periods of more than 30 min Values are specified for different working operations involving emission of asbestos dust during the maintenance of cars compared with trucks trailers and
buses
Average fiber concentrations were about 0.1.106 0.1.106 0.1.106 fibers 106 fibers =
1 fiber of lengths > 5 ...mfor all but one of the working operations A concentration of 0.39 106 fibers of lengths > 5 ...mwas reached during machine grinding of brake drum linings in a truck garage The sampling time for this
measurement was about 1 h
Because of the short duration of dust generation sampling time is about 1 h or
less Therefore the average fiber count for all measurements in Table II was only
66
R^delspergeret al
TABLE III Concentrations and Doses of Fibers With Lengths > 5 m Brake Service in Automobile Repair Shops Concentration and Fiber Dose"
Sampling
time t min
153
< 30
30 < < 60 > 60
n
- 22 22
Fiber concentration X -)
-10 fibers m
5.5 0.47 -0.48 0.09 -0.06 0.08 -0.07
( -10
fibers m.minm.min
4.8 4.8 4.6 4.9 3.7 -2.5
7.4 5.5
eight fibers per 100 fields Because of this the
and the detection limit
precision of measurement is very low
unused filter
corresponds to a count of about one fiber per 100 fields for an
;
fibers In Table III 101 measurements with
min are compared For all
sampling times from < 3 min to 60
considerably as the
working operations the average concentration decreased
sampling time increased For 14 short
sampling time < 3 min the maximum
measurements with
average reading was 5.5 106
concentration was 20 - 106 fibers The
dust emission the
fibers Because of the generally short duration of
if the
average concentration decreased to less than 0.1 106
sampling time exceeded 30 min
In addition in Table III fiber
is calculated as the
concentration is compared with fiber dose which
product of concentration and
fiber concentration the fiber dose is
sampling time In contrast to the
fore comparison of the
generally independent of sampling time There-
emissions of asbestos dust during the different
working
fibers Table IV specifies fiber doses for fiber
times From 40 measurements made
lengths > 5 ...mand for all sampling
are about 4 106 fibers -
during the repair of cars the average fiber doses
m min for
min for dry brushing and grinding and 5 106
blowing out Generally higher average values are obtained from 46
example they are about 10 106 fiber
min The doses can be
.
>5
compared to the limit value of 1
...mwhich has been adopted in
106 fibers with lengths
in a maximum permissible
the Federal Republic of Germany which results
Electron
dose of 480 - 106 fiber + min for an h
shift were
microscopy Fibers with lengths of 5 5
counted at a magnification of x6,300 in the
...mon Nucleopore filters
microscope In comparison to the results shown in
scanning transmission
Table IV the dose of chrysotile fibers
was
considerably higher For instance an
was seen in three
average reading of 20 106 fibers min
measurments made during blowing out of truck drum brakes A
TABLE IV I
Operation
ean
Blowing out Dry brushing Riveting off ar Grinding by ha Machine grind Turning
Phase contras Brake service equal mean val
reading of
. ments made
Staticmicroscopy
microscopy
5...mwer than 1 h..Fil
chrysotile r study 1,219 examined by
percent of th
Other s
Heidermanr 1985 Rohl e electron micr 1 weight-
braking oper confirmed by
few fibers of of dust blow observed at a the crystallin
dispersive X-
in brake drun
1985 There magnification chrysotile fib
Occupation
The occ ics had been e
of employme
Pee
Dose se X -s
10
fibers
m.min
4.8 4.6 -4.9 3.7 -2.5 7.4 -5.5
amples by phase in the breathing
it is very low ) fields for an
min to > 60 on decreased rements with
pers The
duration of
vv m
dose which ontrast to the time There-
rent working
r fiber dose a short
all sampling
e fiber doses
106 fibers
ned from 46
rinding for
with lengths
which results hift
---- filt--e...rs microscope
e fibers was m. min n brakes A
Asbestos Dust Exposure During Brake Repair
67
me.
TABLE IV Dose of Fibers With Lengths > 5 m
e
Brake service in automobile
repair shops
fiber dose [
10"fibres
min
e Operation Blowing out Dry brushing Riveting off and on
Passenger
car
= 40
S 61301
61301
4.7 4.0
-
= 46
Truck
bus
8
5.3
1
9.3
Grinding by hand
7
9.0
61301 3.9 -
Machine grinding
61301
3.9
Turning
61301
-
~
Combinations
-
3.8
-
4
9.9
21
8.6
S
4.4
approximately Phase contrast microscopy of fibers with length > 5 ...mPersonal sampling for < 3 to
Brake service was done most commonly for one car or one axis Standard deviations equal mean values
60 min
reading of X -s = 35 -45 106 fibers min was obtained in eight measurements made during turning of truck drum linings
"
Static sampling away from the working operation was also evaluated by electron
.
microscopy Concentrations of less than 0.03 - 10 asbestos fibers with lengths
5...mwere estimated from these background counts when sampling time was more
than 1 h Fiber counting by light microscopy is nonspecific for asbestos Apart from
chrysotile metal fibers and other fibers may be released from brake linings In this .
study 1,219 fibers with lengths > 5 ...mfrom air samples in repair garages were
examined by energy dispersive ray analysis and electron diffraction Seventy
percent of these fibers were identified as chrysotile
Other studies have been reported on the chrysotile content of brake drum dust
Heidermanns et al 1978 Jacko et al 1973 Lorimer et al 1976 R^delspergeret al
1985 Rohl et al 1977 Williams and Muhlbaier 1982 Rohl et al 1976 In several
electron microscopic studies brake drum dust showed an asbestos content of less than
1 weight- indicating a partial physical breakdown of chrysotile fibers during the
braking operation leading to a large number of short thin fibers These results are
confirmed by our study As shown in Figure 1 at a magnification of 6,300 only a
few fibers of lengths 5 5...mare seen After air sampling on Nucleopore filters
of dust blown from brake drums numerous fibers usually of lengths < 2
were
m
observed at a magnification of x35,000 x50,000 and x60,000 Since alteration of
the crystalline structure of these fibrils is possible electron diffraction and
dispersive ray analysis were also done It was found that the thin fibers energy
in brake drum dust did not differ from fibrils of
observed
chrysotile R^delspergeret al
1985 Therefore in brake drum dust even under electron microscopy evaluation at a
magnification of x6,300 chrysotile fibers of lengths 5 5...monly form % / of
chrysotile fibers of all lengths measured at a magnification of 29,000
Occupational Histories
The occupational histories of 210 car mechanics were evaluated These mechan-
ics had been engaged in brake maintenance for at least 10
The
of employment as a car mechanic was X - = 21
years
average duration
-10 years
ee
aye
Eta!
.
uz FY
Fig 1. Asbestos fibers in brake drum dust Scanning transmission electron microscopy at different
magnifications Upper left x6,300 upper right 35,000 lower left ^ 50,000 lower right 60,000 Whereas at a magnification of x6,300 lower borderline = 14 monly a few fibers are visible at higher magnifications numerous unit fibrils are observed
Si
459 job they ha
generat T
work a type of
of the j
these ca brakes work 7 all othe
M type of
83 c
drum b trucks
'
buses
mainly
been us F
dust ex dose va car Di describ cars re fiber do
account
year as T.
fibers v
was no
The me mechan
TABLE Dust
Brake rep
Passenge
Truck b Other ve Clutch re
Percent exposed t
opy at different
right x60,000 s are visible at
Asbestos Dust Exposure During Brake Repair
69
Since most of the mechanics had more than one employment position altogether 459 job profiles were described Nine car mechanics gave descriptions of jobs where they had not repaired brakes themselves but had been exposed to asbestos dust
generated by others
Table V shows the percentage of job profiles that involved brake maintenance
work and the number of vehicles with brake repairs per week classified according to type of vehicle The average number of clutch repairs per year is also shown In 60 of the job profiles mechanics repaired car brakes averaging 4.6 jobs per week In these cases the duration of repair work was approximately 2 h On average the brakes of trucks or buses were repaired 2.6 times per week by those who did such work The average duration was approximately 4 h The duration was about 2 h for
all other vehicles e.g. fork trucks Clutch repair also took an average of 2 h
Mechanic work activities during brake and clutch repair specified according to type of vehicle are shown in Table VI In almost all repairs either blowing out 75-
83 or dry brushing 54-59 of drum brakes took place Machine grinding of drum brakes is described in 25-36 and grinding by hand in 55-75 of the jobs for
trucks buses and cars whereas turning 6-6%4 was mainly restricted to trucks and
buses The cutting and drilling of brake linings reported in 11-26 of the jobs mainly occurred before 1960. Since then precut and predrilled brake linings have
been used
.
dust
From dust measurements
exposures expressed as a
and occupational histories cumulative fiber dose can
as
be
follows shown in Tables A
calculated as follows
dose value as shown in Table VI is equivalent to the dose for the maintenance of one
car Dose values per car can be calculated if the frequency of work operations
described in Tables IV and VI are known for a particular job Taking the number of
cars repaired per year Table V and the duration of employment the cumulative fiber dose per job can be calculated All jobs of the car mechanics are taken into account The unit of measurement fibers min is converted into fibers .
year assuming 240 working shifts per year each of 480 min duration
The cumulative probability distribution function of cumulative fiber dose for
fibers with lengths > 5 ...mis shown in Figure 2. For % of the 210 workers there
was no measurable fiber dose since they were only indirectly exposed as bystanders The median value is 0.3 106 fibers years for about % of the vehicle
mechanics the cumulative fiber dose exceeds 1.106 1.106 1.106 fibers
years
Thus
the
TABLE V. Occupational Histories of 210 Vehicle Mechanics With Potential Exposure to Abestos
Dust
Brake repair
No. of employment histories reporting brake or clutch repair
work by vehicle
n
%
vehicles vehicles
rerpeapiarieredd per week
-
Passenger car Truck bus
Other vehicles
Clutch repair
275
J28
4.6 -4.6
209
J28
2.6 -3.9
32
J28
3.7 -5.0
278
61
1.8 -2.0
Percentage of 459 employment histories of 210 vehicle mechanics In 33 histories mechanics were exposed only as bystanders
70
R^delspergeret al
TDuAsBtLE VI Occupational History of 210 Vehicle Mechanics With Potential Exposure to Abestos
Operation
Blowing out Dry brushing Riveting
off and on
Grinding by hand
Machine
Passenger cars
198
76 59 86 75
Trucks
buses
No. of jobs = 100
133
Percentage ofjob profiles that involved indicated operation
75
54
93
56
Mixed
78
58 58 87 55
grinding
Turning
Cutting and
26
23
'
26
64
drilling
14
11
26
buses Four hundred nine jobs of 210 car mechanics In 50 other
repairs of passenger cars trucks or
jobs the mechanics did not perform brake
%
distrbuion
Cumlative
iT
T
is
T
T
T
T
T
T
T
4 25 .5
l
1.5
2
3
Fibre dose length > 5...m [ 105 fibres * years
is Fig 2. Exposure of 210 vehicle mechanics during brake maintenance
bution function of cumulative fiber dose for fibers with
Cumulative probability distri-
exposure is less than 3 - 106 fibers
lengths > 5 ...mFor 99 of all mechanics
fibers years are calculated
years For two further mechanics % doses of 7 and 13 10"
average value amounts to X 1 s = 0.54 -1.1 106 fibers
corresponds to an exposure of about 6 months with
years This
1 106 fibers with
an asbestos fiber concentration of
lengths of > 5 m
In 1981 Nicholson et al estimated about 350 asbestos
te afimboerng car mechanics for the United States This number wacsanbcaesreddeoanthasnper year
average exposure level of 0.1 to 0.3 106 fibers Compared to our results of
average dose of 0.54 106 fibers
an
years during an average period of 21 years
that c tion e brake
CON
low fi fiber
Blowi less th
Conce
sampl
fibers fibers micro
fiber
uncert
tained data i the cu to the
been c roofer and R~
exposi
m wit
and pr has bee been ir
out and are cal
ACKN
Project
REFER
Asbestos
as
e to Abestos
Mixed
78
d
8 $
___
87
55
36 42
,
26
I perform brake
3
3
-s
i
robability distri-
f all
mechanics o of 7fand 13 106
This
years
This
ncentration of
aths per year an average results of an 1 of 21 years
Asbestos Dust Exposure During Brake Repair
71
that concentration estimate seems to be at least four times higher than the concentra-
tion estimated in our study Four cases of mesothelioma have been observed among brake repair workers seen as patients in our Polyclinic Paur et al 1985
CONCLUSIONS
Asbestos dust measurements in garages during brake service operations show low fiber concentrations typically about 0.1 106 fibers average and also low
fiber doses
The working conditions are generally characterized by short exposure
Blowing out and machine grinding take only min and the time taken for turning is
less than 1 h per vehicle
All results are considerably below the existing German Technical Guiding
Concentration TRK of 1 106 fibers with lengths > 5 ...mwhen a minimum
sampling time of 1 h is taken
Electron microscopy of brake drum dust does not indicate a high occurrence of fibers with lengths > 5 ...mhowever there are very high concentrations of short fibers Mass concentration of asbestos estimated from scanning transmission electron
microscopy indicates the mass of fibers as < 1 weight- R^delspergeret al 1985 Fiber concentrations for certain working operations are characterized by low
fiber counts and therefore by a high uncertainty factor Furthermore there is a high uncertainty in the knowledge of the frequency of different working operations obtained using a standardized occupational history However the inconsistency in these ' data inasmuch as it is measurable has no great influence on the calculated size of
the cumulative fiber dose The data also allow the ranking of the workers according to the severity of exposure
An average value of a cumulative fiber dose of 0.54 - 106 fibers
years
has
been obtained This dose is one order of magnitude lower than an estimate made for
roofers cutting asbestos cement at building sites R^delspergeret al 1980 Woitowitz
and R^delsperger1983 It is about one order of magnitude above the environmental
exposure which in the Federal Republic of Germany is usually less than 1,000 fibers
m with lengths > 5 m
Some changes in working conditions have taken place Nowadays only precut and predrilled brake linings are used Machine grinding is less frequent for cars and has been replaced by turning in the case of trucks and buses Exhaust ventilation has
been introduced almost universally during grinding and to some extent during blowing out and turning These changes have to be mentioned when cumulative dose values
are calculated from results of dust measurements and occupational history
.
;
ACKNOWLEDGMENT
Project Supported by the German Federal Ministry for Science and Technology Bonn Project No. 01 VD 2900
REFERENCES
Asbestos International Association AIA 1979 Reference method for the determination of airborne
asbestos fibre concentrations at workplaces by light microscopy Membrane filter method
London .
72
R^delspergeret al
Hauptverband der gewerblichen Berufsgenossenschaften e.V. ed Heidermanns F K^...hnen
A Prochazka R Riediger G Woitowitz H Valentin H Henke R Woitowitz
G Sch^...tz
KP Klosterk^tterW Bruch J 1978 Untersuchungen ^...berdie GesundheitsgefahrRenHduHroclhzShatu^s/eurbe
asbesthaltiger Bremsbel^/geForschungsbericht Asbest Bonn Schriftenreihe des
der gewerblichen Berufsgenossenschaften V.
Hauptverbandes
Asbeststaubgef^/hrdung Jahn H R^delsperger K Br^...ckel B Manke J Woitowitz H
Bremsendiensten.Staub Luft
1985
in
Jacko MG DuCharme RT Somers JH
80
83
operation Automobile
1973 Brake and clutch emissions generated during vehicle
Lorimer
engineering meeting Detroit Michigan May 14-18 pp 1-20
WV Rohl AN Miller A Nicholson WJ Selikoff U 1976 Asbestos
workers in the United States Mount Sinai J Med 207-218
exposure of brake repair
Nicholson WJ Perkel G Selikoff U 1981 Cancer from
1980 2000In R. Peto M. Schneidermann
occupational asbestos exposure projections
Spring Harbor Laboratory pp 87-111
Eds Banbury Report No. 9. New York Cold
Paur R. Woitowitz H R^delspergerK Jahn H ( 1985 Pleuramesotheliom nach
3be6i6Bremsreparaturen im Handwerk Kasuistische Beobachtungen PArsabxesPtsnteauumboglef3^/6hr2du-ng
R^delspergerK Woitowitz H Krieger HG 1980 Estimation of building sites Biological effects of Mineral Fibres Vol 2 Je.xC.poWsuargenteoraLsyboneSsctioesntdiusftiocn
Publications No. 30 pp 845-853
.
R^delspergerK Br^...ckelB Jahn H Manke J Woitowitz H 1985 Asbestemission bei
gen Reinhalt Luft 26-31
Bremsvorg^/n-
Rohl AN Langer AM Klimentidis R Wolff MS Selikoff U
tered in brake maintenance and repair Proc Roy Soc Me1d93727-A3sb7estos content of dust encoun-
Rohl AN Langer AM Wolff MS Weisman I 1976 Asbestos
repair Environ Res 110-128
exposure during brake maintenance and
Ullmann
D.
Eggersdorfer
R
K^nigR
1978
Analyse
der
.
Asbestindustrie
im Auftrag des Umweltbundesamtes Bericht
Bericht des Instituts
Williams RL Muhlbaier JL ( 1982 Asbestos brake
4/78 Berlin Erich Schmidt
Woitowitz
H
R^delspergerK
1983
emissions Gesundheitsrisiko
Environ
Res
70-82
Berichte 313
324
bei der Anwendung asbesthaltiger Produkte
Patt
Kenne
ARRED<PZ^ S
AR ED<PZ^ S AR ED<PZ^ S
ARRED<PZ^ S
ARRED<PZ^ S AR ED<PZ^ S ^ "
522
522 522 Key wor
INTRO Pl
asbestos used to resident exposed
Th
Pipe Fi
represe
concern
about th mortalit years 19 local un
Environm Address 1 Cancer In
Accepted
'1986: