Document jNE1BE6o1zNdrze3XdJgx2Dgk

ABERDEEN CHEMICAL PLANT-^lWiY RECORD NS 0653 pufr/r e/tmrm/t/c fox Nam. . ___ShUt----------Pat. sfofevi VW4/M flP/v M&nfftMi Social Secur ity No """ Job Code r ~ Start _________________________________ 30InstrumentNo.J^Zj:___ Time___ AMp^PMf ) ^'JQ AM( Stop Airflow______________ ________________ HAZARD * VCM Lead Antimony Total Dust Noise SAmS?T5ai)'0N <?PJ-PPM -Microgram$/M* --Micrograms/M^ --Milligrams/M^ --% PEL Sample Time. 80 HR<> PEL: Q --Micrograms/M* 115dBA->^ ^es / No AnahJ^ Y ~ Analysis Date NSHazard: VCM ( ) Lead ( ) Antimony! ) Dust ( ) Noise ( )( ) 1.1 came to work at. 2.1 left work at___ AM ( > AM ( ) PM ( ) PM( ) Firewatch Work? Yes / No (Circle One) 3.1 did the regular work of a (enter Job Class) 0653 Scott Alr-Pak 3M Air Hat 6. Other comments and information (Use reverse side of card) Signature______________________________ Please complete and return to Guard