Document YG6L3v5mmraQzZ24OEQQ1JbXn

R&S 009220 ^ J J J> I f VCM Epidemiological Study - Individual Work History Form C - Workers whose vital status is unknown 1. Date of birth ~ : - - t i 3. Date o f retirement 2. Date hired Cl - 4 A. Date of termination 5. If we may trace this man through a retail credit bureau, which will not directly contact him or his family, please give his name and last known address; Job no. Job history with estimated exposure Title 1 from ~7 ^^ to 2 ____________________________ from to from to from to from to from to from to Check estimated exposure in ppm ^50 50-199 200-500 ^500 i