Document e55KXvRR8mQy4OqE1mzBO07bm

Environmental Health Associates, Inc. Epidemiologic Study o Vinyl Chloride Workers sponsored by Chemical Manufacturers Association Please verify or correct the information provided and supply nation requested in all blank spots. If information is unknown, ate with UKN, and if not applicable, NA. EHA USE ONLY ID Pib-prolepn ChpmiOa t P/onf )vee Name 1-5 _ Last) " (22-29 F?rst) 5SK II . 33LZ (30MI) 'date Date 0<1 . <4% month day year ($8 t ^0 month day year Last Employed,t month day oyment Status P/r\flo l/'? o! of 12/31/80 .1 Status of 12/31/80 //' Df- year lead: Date of Death ,j month day year ice of Death City, State Foreign Country Comments or other information about this employee i -WV Study ID l JOB HISTORY ***** ********* ************** ****** * **P*LE*AS*E INDICATE ALL JOBS ********* , *LE*A*VE*S/T*E*RM*IN*AT*IO*NS*A*ND**REE1*IRE*S*B*EL*OW* * Exposed = i Start Date End Date Job Title Unexposed = 0 0i MW P'lp-70 2-cx h e e- / thj-7d hU -*? / A^/h "/D'' /-& "Tec/-. X )~7-1 1 5-t, *0 " /-ct/3 "7Vg/C. / 1 7-U,-7 ( Prob . i-&b '7'eeA 1 > > 7 ) 1H6-7I 3 'V li-H'7/ 3-iq - 7 3L B'Q.l-7 3 La_k 7eeA . P/oh. "A " / Tee A . Z.aX> ~7eoA _L i / $'<52-7 7 S/*/-7 V 3~3)~ 7</ ft>-/7-f 1 '`fa" La Jo ~7t q l /? t o q ^ lea^al 'Ttchnieia 1 i jtwsf'g l))fl\J ! PfOch\(i't<or\ SQ^c/olrr 0 &AL 0001047X7