Document a4YzKELm9rDvvwz2KLqRxqkLb

ABpDESN CHEMICAL PLANT-TOiftltflY RECORD^ N2 Name. / i&L Date .Shift 1339A Social SecurifyNo. Instrument No .52V Noise Cell No. __ ___________________ Job Code___C Start Time -7t>U ,amo4pm( Stop ? <?Q AM( )PM(UK^ Airflow JHAZARD VCM Lead Antimony Total Dust Noise SAMPLE CONCENTRATION (Time Weighted Average) /. / -PPM --Micrograms/M --Micrograms/MJ 2 --Micrograms/M*3 --% PEL Air Vnl (I itwO PEL: o --Micrograms/M 115 dBA? Yes / No Analyst 9^^-*-^ y Analysis Date Z> ~ !1 d-v Z) ABD0033&805 r^arCf: y.CM \i>f Lead { ) Antimony { ) Dust { ) Noise ( ) N2 1. I came to work at__ 7-- 2. I left work at ______ 2- AM AM PM Fireyyqtch Work? Yes ^No^jCircle One) PM t 3. I did the regular work of a {enter Job Class) 4. I used a respirator during the following jobs (check'one) yA/A Oust None j __Mask scott Air-Pak 1339 3M Air Hat 5. The following unusual events may have caused me to be overexposed: _________________________ \_______________ J 6. Other comments and information (Use reverse side of card) Signature