Document gEr2b2RwRBDeaLLJJDJp2owL

PROPOSED REPORT FORM FOR FIELD TEST OF DECALCOMANIA LEAD WARNING SIGNS ' Name of station operator Address of station Mr. Paul Johnson 6000 West Addison Street Chicago Illinois C 0 p Y Date decal mounted August 2, I9U8 Decal mounted by George W. Rose Surface on which mounted (painted, porcelain, other) (describe) New porcelain pumps Remarks: 8 pumps with lead warning decalcomanias mounted on each side (l6 decals in all). First Inspection Date November 22, 19^ 8 Check following conditions as they apply: Unchanged x Faded _ (Slightly) _ (Badly) Torn' Scratched _ Discolored., Second Inspection Date 2-b-h-S Check following conditions as they apply': Unchagned _ Faded _ (Slightly) _ (Badly) Torn _ Scratched x Discolored 0009433 2- - Third Inspection Date 6-8-49 Check following conditions as they apply: Unchanged Faded Torn Discolored (Slightly) Scratched SEE PICTURES (Badly) x 0008434