Document k9n1aOGemVoR1VO358oRdaZ5O
FILE NAME: Ford (FD) DATE: 1978 Apr 6
DOC#: FD233
DOCUMENT DESCRIPTION: Unpublished Internal Report - Industrial Hygiene Survey - Clutch Assembly Area, Dept 4980
..p : | `'
inter OHice
Mr, c. J. Augey, Manager Cleveland Engine Plant
cc E. F- Arseott, M.D.
R, J. Daragon
j. McBurney
.
J. Kirk v ' R. B. McGrav R. 1 . Manthey
C. Nadig
/ 'Hl.'r
.f \r;~- -
*.'*/* ,,
..!jSv.
.ip
*'*
Subject:
T h 1rtrial Hygiene Survey - Clutch, Aese&bly Area - DeparUe
Industrial aygi
,
.
Airborne Asbestos
c';
;:V
.
T Kirk Induatriai'ilelationo Supemaor, ann Ab requested by Messrs. ' Engineer at Cleveland Engine'Plant No. 2,
J. M S h w , S t Sa^ 8f " conSLtid ft* i i X l u i t U " of * > * " m nduttriSl hjSint Mr.e? M S e U j reo^^Kat.rUl.taodlioe ^ * d
to removal of the
mftnual transmissionengineblock. Br0ar"" .0
etallation of them on the f ^ m^ eQ froi^ r w STmbly;iine ,and containers
-- "* S E^STrocSurea relev^^^onyoncerning
for assessing nanoiing p
cleaning p r o c e d u r e s ^ M M w - V i ' .
aabeetoOsS coonnvta.axiiniji.nuge w~a~s~t--es and -^" * " ' .
.
,
,, ,, . l o d breathing
a W
S S LS W ? aerved within bulk samples revealed no aebesu
p r e B e n t a e m b l y raila eand l e w
"
P olutch'~`6BBnbly boxes. ^Laboratory
one percent chrysotile Pr00
Sdicated aebeetis usage in toe clut^ .lh
analyses and current regulations
^ ^ y ^ ^ p r e a e n t no health
assembly area as *aaur0d
ch aa'^pty boxea' being thrown into th
hazard.
V
^
me Attachment
p ,vjr,
- Vv-' -
- M B t e l - j W < 4 * S i + l - Departsest ..^ I n d u s t r i a l -
,>;ssHsl
V '
012976
-..t V
-
. 1 - . - ,
.1
^
.
Data Sheot
-
.
. 3 .0 ^ - a a a fljB K -i
M , . P - * *> - Depextment. W M - O M e h teremblj
March XQ. 197^
'
*
P.nBi.eibl. Oeeupeti! Expobut Ii-lt. to
euble elrttatt[ ot (eootUBieeted)
Plb. , 0 per oo = ribera (oC e.b.eto.) looser t h 5 oicroeetere per oubie ce
Asbestos
Wbrsetahthiinneg ltone air 8-Hr. Time-Veighted Av k . Sgp. li-glit
2.0 fibere/cc
Ceding Concentration 10.0 fibers/cc
Resulte
Short.-_T_er_m tmoaure Limit**
10.0 fibers/cc for 15 minutes
aploye
Soc. Sec, ii1
Bentley ! scheuring
. C e o rg o p o u lo s
B , Bentley , Scheuring
. Bentley
299-J*1^ 3 5 3
21-60-5539 261-5&-25 ** '
299-i`1^ 3 5 3
281-60-5539
n
it n
299-^353
rea eainpl n n ulk ( a B s e a b l y line)
Asbestos*
0.07 <r 0 .06
1 .*45 ^ 0.093 c 0.099
0.093
^0.093
^ 0.087 o .io U
0.09 Hone detected
" 1$ chryBotile
Location & Position
Clutch assembly operator
n
(carts loading & unloading)
.
ti n
a
...n.Klv line - opposite assembly operators Directly across assembly u s e o f h
Semple taE ea r o t . t im , ta b le v b e r .
b .e .iP S . -- ! * " *
a . of accumulated dusts and oil on engine lino
A U samples are at or near minimum detection limits Ford Motor Company S t a n d a r d Sample data retrieval numbers: JHS 37 ^through IMS
&1uipment and instruments. ^ " . ^ feco filter"
^ micron
filtorB in 3 P ^ e caeaettea*
ConsUitants using approved iflOSH counting methods
p i ' " '"
vi;P'
Vp
FORD MOTOR COMPANY . .EMPLOYE HEALTH services
.
- ^: 'innduuusatr. nia^l Hmygi-e.n; e. ;.
AIR ANALYSIS sam pling data SHEET
Q ,3 |[ i lO lP l
Data Plant
RRaccTTvypsa KI f i AB l LUabbwoaraltoorryywNpo..y;:. . ~ . ~--. r..." V -= ^ =~T
au,,. B S M S t ^ i S l i E P ^
'-"""-n .* ' ' ' -,
'
G Z Z S I3
Work Station Location .------------------ -----------------
-- ------- ----
Work Operation
_
' '
.......... -- " *
-,
Matartela/By-pruductJ/Suppnan---------- -------------
z-i--
.- * ,, *<*$:.?
V
. -Fe'iy'.etv-
'iw
' .
. . . 1 L
. .
' .
__
Manufacturing ctonHurri NoS.
! I l I I I I 1 'I 1 .1 ' 1 !--
..J lit}''.'..-' >'iV t i i t it 1 r r i |V l-'-' l " ' u i
t ' ' i " *1 "l : T ' 11'- - 1-- J----itV s t1. ' n -
L Production Rat.: M Q Normal U A b c v a H o ^ ^
Bnp.oyeNam. B>-- *-J j - / 1 1
--=
t-- I . ...,,-w
.p- 1 K11 y-.-V.-/*l*.. vr'.i-.vPr .
' ......... ..
Jdont No.
job Tiit-le_:_ S.g, tAl iSJiiO
,, a
HourafSNtt
l , noth of Wo'rk Shill ..
e g g u - i . ' rr? ,, j r : -
--;
* * " * : -
**}**'
;
. v|
':' i
i
{.
"
' i
S a m p ,. Type -(C h a c k BZ. 0 * or S2 end I S or_FD> - ` ` ^ 4 ; ;
0 Breathing Zona ^ General Area
. Q Scure. Zona _
CSutroratorySampi . Field Determination.
. '.j
^
;.,
Mr Sampling Method . f i f a . * " " Dust Flltar . X
Charcoal Tub.
Ito .<WTuba O a .ilm ^ g a r
n Direct-Reading Instnimant Detector Tube U ESP
Qaa Sampling Bao Qoa Bubbler^ ( I Evacuated I
O Tape Sampler Other.
Semple Baele (Circle Ora) m T Management Request B - Follow-up Study
. . ,,
T - Medical Department Request D - Union Raqua.UGriev.rco ^ ................................^
E - Subsequent to Regulatory Agency Study F - Research
,, v,r ___.,,rum H - Employe ComplalnUSuggaation J .
V
.
__ __ _
.........
' _ ' '
^ ^ "
012973
,,
'
; -- me*-- *
SAMPLE.
COMTAMINAKT Total Dust/FIbar
Respirable dust
MAJOR .
; . . u - ifite . " *' . `i ^ ' r
; 'n * j ..
.OTHffl .
_. .
:
Fume Mist , . Smoke
,'*V. -!tv
'
' .. -. ` ' v - V ^ V
, '
f. "
Gas
Vapor
; ' .
**,, '
'(
. , - - .......- S aifcgax.4
Sfliial N o .. Pino) fitter Weight _ Initial FIHor Weight. Pump Air Flow Rato Seal Raiding:
filte r Typo & S ilo .
_______ .mg
.mo
c2.* S ta rt-------------------
- vi'.
1 -"' ..ri> . Qltfornee 1 ' " *
(--- .....
r*. t\ '
** ;
" -1
--
. mo
:mes)
Average Air F lo * FUto;
---------------- --
to
<T.SJ Sampling Time: SUft
__ s to p .
I
Bepsed T l m o : ^ i d --
. minutes. Air Volume Sampled .
""
/"Tn
-
Laboratory ... ^ \
1 CONTAMINANT
i
BASE
CODE B1 B i "
ANALYSIS MCG
FAC L
:''w- 'T T s r ''-<?. : "`r - "Perm issible ; .
TOR T . . MEASUREMENT^', : - j , = r u ^ . --
- \ J i v n >_r^ 1
1 '(J 1 1 l
3 , dco
* 1 1 1 r -- 1-- - t
`
r
i i 1*T
i 1i i i
; i i__ 1___l-- l--
i :: t i i i
` 1 1 1 1 1 -- __ i__ i__ i--
Engineering & Administrative Contfftli
L O t O . 0 i 0 0 / t iO r O - |- r '( r 1 1_
.t.' i `r - ' r ` l" 1 . * r : y
t ' i j_
i
* i w r r - Y :XV t r i i i _
'' V L M ^ i -S: t t r :^ ' ^ iN 'r n
t it r if i , ' r -Je --1 <?-1 f
1 1 *1 " 1 i ! ' i - * v i r i t i -
.
.
.
i"i-sf-i' ''
o -- , . i . . n ............ V . h ' . i . J 3 M . - O * * O i u h w .
,
hoot Rsdiallon Cutaneos/Ooolar ^ a tte U M -.D jIlum fraU o n
'
v . ' I
^ , Vv. ' I ].
C o m m e n ti.
.w.Sqgoyr~
Industrial Hyglenls
.
in n ^ 'o - w
. MsInL Cd. v C
v R " ' .
I-
01
*
Nr*: . 7,
` .: V. i;
v;\ -\v
fr \
'.
t*. .k* ... ..............'
.<'
is; '
'--;V:'f`.<.:l!< ">-- s'
**:v.* '
`.t.'
V
' . - - a1;# - i"'*,. __ivw*.-' ...,-s*-k.Oirrj*
Vvd.t.:.
-.-*S
:
1P
MOTOR COMPANY
''
EMPLOYE HEALTH SERVICES
__1
................ ^ O U S T R S /i H Y G '^ N E
AIR ANALYSIS SAMPLING D A T A SHEET
OiU [Lq]1I23. RooType E.
Laboratory No.. Sample Oeaignatlon &
Retrieval No. ..
Standard Nos.-----
.
. . . .. .
ti N,,..
B g Q l^ < j ! d i ^ i i.-i-i.
Employ Name L - J L - ^
| r -T ' , .... ' ...........-
i p i w r Job Tltla 3 - l ^ l O i .1 r !_a ^
S Shltl
Length ol Work Shift
1Q.C -------- ..:
Hours/Shlft r ^ g j- 40ay<Wk.
atthisJob ' I Q .
" - * "
.....".........."................. - - irf;v...V; ^ ,
Sample T y p . (Check BZ. QA or 5Z and LS o r j =0)
.'
g Breathing Zone Gener.lAree
.SourcaZona: ^
81 Laboratory Sampla Field Determination .
_
S X ' " V V ? j :. _ ^ A*
.- - .? `' '
AJ, Sampling M.thod f l B it P - 'iJ * 0urt flMw
Charcoal Tgb.
SIHcaG.I Tob.
Direct-Reading Instrument Oe.ec.or Tuba U ^
^
T ^ f f T T ^ T -
Q ^Ges Sampling Bag < * * < * ' O E v . c u a t e d F l a ^ ^ ; .
V
Tap Sampler Other-------------- * * ' }
j
.-' '
f A 4Manaaomunt Roquvst da -.r -- i-.'u
u
I ' l l --
-
- SobeaqiiaM to Ragulatoryhgonsy s * r
"
..
Q Oanarai Sarvay .H - Employ Compl.lnbSudOe.don .,
u W f f $ >- '.. ;
u U w ' h ^ w a r k Stat
.1
012S2Q
I
fX'V'M'T fi''
SAMPLE
CONTAMINANT
Total Dst/Flber '
.
Resplmbi* Dust
Fuma Mist
- . .,,
Smoka
Gas
-, .
Vapor
MAJOR . .
...
- -.-,i'WVla--rVV^,.
'
R -d *vf "< . ' ; '.feiaVaV
v*'
' V',
': ijt- __.
'
'' :'*'t
- A - , , - : . i S . T , *
Air Sampling SarlalNo. j M
-^ -J & ---------------------- FHIer Typa A S I
F in -F H - w - , ------------------------------------------ ---- * 0
:r p
'it
^
'iTlI'.
t L -- ^.
;tl.,
/ mg
.
Inlgal Filler Walghl-------------------------
j T ggH .'
Pump Air Flow Rata Seal. Raadlng: Start------}k----------------- .
'. ' V '. '
Average Air Row Rata:
^ --------------tara/mtaut*
-T- ;^A* A : 5o Sampling Tmr A B.psed Tima:
Start * L^ - ------ --
Stop i-TM - Air Voloma Samp.!.
fmt of Measure
lltara.,3" "P' .
laboratory . '- w * r \ v - t - s -
CONTAMINANT BASE
CODE B1 B F
analysis
MCG
\\y lf^\ '. c n1 ' i3 i.--s ;-- i,__a.i__ ^.1 :i
l 1
t _ J __ 1__ 1__ 1-- 1-- .
` '
1
<
3
fp o o ----"
__1- i - J __ !__ !-- U.. 11 ` *>--j 1
! 1 1__ 1__ 1-- ,
:
.
1 1 1__ 1__ !__ __ !-- I-- I--
Engineering A Administrative Controls
''A*1: : fac- L .^Uw*u`tST :
-
PERMIS!!18LE
TOR .T -j : - MEASUREMENT^,^ /V .-.;.,t:UMIT
,
>' L , O , & 0 (< i, 0 P- ..;wT/'i;Y.'vvy.V!,*fT;i; L?. . -i I 1" .T. 1' 1' 1- -1 ''
l'* f l 1 . " '
*" 1 1
'j i' .a.i' .` /.y: '-dViu.-.
1 i - t * T -'Y :" 'I "
v . 11
.l -J--
i t i * i "t- t - i 1 1 1 1 - i n M V . i -v
PersonalProtection Dih-U
Othar Potantlll OccupallonFStreae: t t h * Q Haat Radiation D dulSnaon/Oc-ilsr
Comments
...
.
O w M d P B lo fo g io a i^ ^ a w r^ T ,sVmeifoo ,, ' D I n u m h a t l i n ^ ^ ^ f e r ^ ' : . ......
' 'V:-yVj.-iI1*->-Vf-.--,1Uv-r-.i' --
..
,'-
-'
"
v"~:
Industrial Hyglanist c ^ S g q & v r j=
012981
FORD MOTOR COMPANY ' 8 ^ . . EMPLOYE HEALTH SERVICES
' INDUSTRIAL HYGIENE AIR ANALYSIS SAMPLING DATA SHEET
lOiS lfi lOlH I
Dam I-- J1
-
Plant Dapartment Work Station Location _
Rec Typ s a
frC i Source
Liberator/ Mo.
Satmpolii ODieissiiagnnation & r \ * . k , < \ ~ > O , Q f l - 5 . 9 1
Dali Removal No.' h e I ' " n r I
----------------- "
Building
Bay/Column No.
I I
!..
--~ ~ IS r n T T T . J , , .
ot^tOporabon
y
1
'5 5s^
Malonals/Byproaucta/Syppllera -
Manufacturing SOltAaHnUdtaJSrdV Kos,
I ' ' ' * 1 1 !--
.--------
ii'iii-
_i_i_i-- --
.1. l.-U1 .
---
Employe Nasmnieu t!--I ' - --' -------- ----- i
Idem No.
Job Title j^ .Q A 5& ]o L'
ewit i*-, r
Length ol Work Shut----- ^
' Hours
Kours/Shltt [ M B . 4 Days/Waek. [ ^ j a n h l a J o b
Semple Type ' (Check BZ. GA or S I and LS orF?) .
Sreathino Zone ' Q * " *
2 ! Source Zona
H Laboratory Semple Field Oeterm'netlon
Sampling HethOt. . - 8 Filter B e e t l e Dus, f l u .
Charcoal Tube
S * M Tube Dustlmpnger
Dlrect-Beaulng Instrument Detector Tube O a s S a m p lI n g ^ . D G o b b l e r ^ a c u a t Rack ;
\ * * * Tape Sampler Other _ _ ------- f . ; V "
.
SaointeBesle (Circle One*
.
U k y Managemont Request B - Followup Study .
Y - Medical Department Hague,, D - Union Reguost/Cn.vanc.
_ sub0. au ,t to Regulatory Aganov Study f - Research
a - General survey ...M l-- Employ ComplalntlSuggesflon
Sketch at Work S ta tio n ________
012982
iV*a
sample
COMTAMINANT j Total Oiist/Flber ' ' ' - ' , Respirable Dust
MAJOR
\*,~rifJ6r . ~ - M \
- ';...
Fume
'.
,*;.V
Mist
Smoke
.1
Gee
I
'I
Vapor
\
-
|
` .*' ri" *-
,
' - V "r*--.
i
' . 1 "' :* /- ;y .:i
---------------------- ---------^ ------------------- ------
.-
`
- '
-. ' '
:
Air Sampling Device Serial Na W Final Filler W elohf
N
Typ. L Size.
mg 1
,'
,
V
OfflerwK* --..........:
r*r-, ;/ r .: ;f ;
mg ;
Initial Ftitor Weight
.m g
JS'mtfl" !
Pump Air Flow Ra! Stale ReadlHQ: S ta rt.
SlOP :*V/' >-*--i-<-w-------^ y.SiC t.7 ^ : : ' "
i.-
r.-Hprs * f f
*
Average Air Flow' Rats: '
- ___ntera/minutc . Ft-t i''Va .v ..x.` iW i...r.:rr. ; 'i*.
~^ f ;
<1fl Sampling Pme:
. Qepied Time:
Start.
LBDoraiory -wi ^ \
^ S l?
stop i ^ " - : . . ^ i W ^ u^
***4-'
^
,
. minutes: Air Volume Sampll.v 3 - P k
;iKet 4 4 - V , -i - ' ' " -'
.. v:vaifc4>J'3*^&
' ' '!L A *t Ol.K>nitiSP ^
CONTAMINANT BASE
CODE * B l 82 "
ANALYSIS MCQ
FAC L ' :: ;V:iTST''' "-,:!^ * V l - 'PERMISSIBLE ' .
TOR T L MEASUREMENT
. ' M4 t \' UM,,ff - i
G iO l \ 3 | 5 ,o L *1
11 11 1i )-J-1----L-*m4 | | 1i r
OP
L 0 .0 ,0 , l ^ t 0 ,0
, y y.
^r'v -r^ 'H - ' l -
i
i
>'1 !
|-t 1
iii ri 1 1 '
1 1 1 __ !-- 1-- L_ J__
M r^ , i
- .>;;vTir--t,-y ? t i i
n
**- r f r -
Engineering & Administrative Control, ^ S .
Personal Protection Q , l , M ^
Other Potential OccupatlcaCSl: : 'HO O Heat Radialion "OCCtancj/cJeuar
- " - 7 i , J ,
D v fa $ 2 f *S D ^lo ile *J ^ ^ J TM o n o m lo " t Senltafifln ^ Q
Ma- l-nt'd*r.fi-',3.1!:'i-.sCi- Tr' O"TR''
5 |K , v v . .-.
# i^i1 ''.*%** -.
012933
. --. 'l ."
n
1
' ' ' "
: ::
*'y- ..; >'': '
;w' r i V yf - w '.-. .':. L
i-Cf'-'^vS'
*.'. , ",'** t ` . . v :,*' :* * ... * '
______ -, .- y Lf.y.i ': - -tT. - . -
------------ : " ';
!
"
.
- i
FORD MOTOR COMPANY ' ' " ^ ^ I N D S T ^ ^
^ . m a o v a health a s m e * m g M H M H R
Oats p s n a B E
1. ' - -- --
'
f# n
Svuoi* Datanti
V ` Plant ^ i i <
, V..-I
Work Station location _ _ -- r ^ -- --
r-v'i
Work Operation--------- :--------- ---------
j t 'Jr?.? ' : 7 y* ; ;
Materlala/By-products/Supptlera-------
. ! ......................... , t _ L _ L ! .1- i-'M :;r . 3 S E ! L 1'+**1
-----lJ-- - ' H i - I ` 1----
L^->^V-:
Stan.d..a.r..d.. N...o..i........J...--.... L
I i J-- L
..
_
' ' :.^ .ii-^ .,% yr;}y ^ '. `'X k ''-'' '' '
Ir
Production Rata: Normal O AAb rbn^mrNmo raml ^- B a t o w N ^ ' * * *
,v!/'
^ -------------
'v>' Employa ama tU J 1 1 , " . --p
-rT-**"
^
-Job Till -
Shift
Houf/Shlft
i ^ ^ ^ ^
: J 7 * - A .'> ( -s
L*ftffth of Work Shift
4
*
-
'm
.?
i
O i $ ,<3 i oays/Waak
Samolo TYP* (ChactcBZ. QA or SZ and IS orFD)
..
S ) Breathing Zona , Qanaral Aria
Sourco Zone
[0 , Laboratory Samla O Raid Datarmlnetlon
s" aT
vw0^ft!f*ri$V`a *&
g8awj'rj?-tA iy 't--
4# ^ y p 3 k .f:^ LMiuMt4r tv lt-
' < ' '
-A-. ^ --- , I
. >:. .
charcoal Tub.
SlUcaGel Tuba
Bract-Reading Irtrumbnt Datector Tuba U
L
G Sampling Bag. . GoalBubble,-
S
TapSampler O ther-- .,
. ; 1
S. amo_lo__B_a_il_a (Circle MOne)
. . .
I O Management Raquea!. B - Followup Study
.,.3i*is
T - Medical Oapartmant R .qu.at D - Union flaqu.t/Gr1?^ .
B -S ubiequom to Regulatory Agency Study F - Raaaarch
a - General Survey H - Employe ComplalntlSuggMlon -:
'. , ;, ; -.v .
.
^ '
~ '
***w k & *". -.-. ....
Rei ^ T O -^ ^ iA'-t'rr~ - r 'V/vT-
fc;a4A<\*J
012984
SAMPLE
COMTAMINANT Total Dust/Fiber
R espirala Dust
Fume Mist Smk
MAJOR
OTHER
Vapor
Air Sampling Device <
Serial No.
------------ -- Type 4 SU.
Rnal Filter V/alght Imniiotial Friiititoeri WTewigyhiitv---- - ----------------------- '
mg ____.mp
Pump Air Row Rata Scale Reacting: Start P * * ^
.AvaregaAlr Row Rate:
s 3 .P L
_ lltere/mlnute
Xi Sampling Tima: Start 1 V
EUosfld Tima: ........--
3 l _ _ Stop__M____ __ minutos. AJr Volume Sampled
Difference-.
( - ---
S to p ____
Unit of Maasufa. . liters
Laboratory---------- \ '
CONTAMINANT BASE
CODE S. B' B2 f
ANALYSIS MCG
FAC* ' l TOR T
TEST MEASUREMENT
. mg ,, mcg)
Sii sh 3 '
PERMISSIBLE LIMIT
.Q .I ,5
1 1 1 ' ' til!
' 1' 11 1
, , -1 1 4 ;
I
1
(,.00 0 -- i---------
! 1! 1
------
1
*
1
1
-- 1 i 1- <
i .*'
1 ' : 1 : i k.
! - 1 -----1-----!-----1-----1----
Engineering Administrativa Controla
0 .0 .0 .0 -0 8 3 0
111*
I t -i--
i l i * ___i i i -- ' ' l l * 1 ' 1 1 -
! 1I t 11 I I I * ___l _ J ___t-- 111*11'
1 1' * i 1 1*
1 1 t~ 1 1 1
1 T ' " * 1 1 t . _
Personal Protection o. n. r^r^i
^ -
_
O ,., Potan.!.. Occupational W . :
-Tobe
Heat Radiation O Cutcneaa/Oculir
vipM.tor \ Biolgica. D Ergonomic
Sanitation , ; U Illumination
.
Commenti.
indonnai HygienUf^ ^ )
--
. Maint, Cd. C D R
012985
..
A": '
. `j j ' ".i ,
, - V'n; ..
- - 'V '
: - : ' .
: v :/:
FORD. MOTOR COMPANY EMPLOYE HEALTH SERVICES
" INDUSTRIAL HYGIENE ...... AIR ANALYSIS SAMPLING DATA SHEET
Oats I Q | 7 ~ 0 '1 1 ^ 1
Plant
Department IQ.tUflUi
Roc Type
& 1^ PT! hLl
Laboratory N o.. Sample Designation L l- r - r , r i -- 1O O 1O i H i Oat Retrieval No. . L j 1 1 " P .
& V
Building.
Bay/Cotumn No. J __ L
Worit Station Location --- ------- -- --------- -----------
: r : - ` . .. . .
Work Operation
$ L 'fc k
.............. ........... -
'
'
-`
Matenal/By-products/Suppiieis-------------------------
- ,1 . v'J ,-T . V - " ' ' --
Manufacturing Standard Nos. L
,I i[ _ 3i- - - - - - - - iL. `i i1 i1 " i . 1
r
-
-
`
---
-
1----rn1)----
1......1.....
.1...._.J._.._.
1_ _
_
_
1 1- -J---4.__1.-- L__
t.; - 1 turd - . r P _ L _ J ---- l J
1 1 1 1- 1__ L_J-- 1-- ` * lssu l*.;. . ........
.
................. n ihouA Normal C ] Below Normal Rale.TM-- L-. Production Rat: LJ norma; w -- ,,-- ................................................ ...............
` Iffl Employe Name I S *
I
S s . | k i i T i L i f e i f i i i r ' i ' 1 1- ; " ..V ...
1-- 1
'
.................. . . . . .
....... - f i o t t i S B ) E S
.
- -fe Job Title C Shllt r a
Haurs/SMft
* A". . s , s , l --
^ y i3 * k `f . ' O
. < * O J ADavs/Week " ?L 1
J v i * r __________ :_____
- Hours ^
at this Job
, .
.-
Sample Type (Cliaelt BZ. GA or SZ and LS orFD)
a Breathing Zone 0* --
Soere. Zone .
E Leboratory Sample Field Determination
:
1-54
J-4j ` i*/'
o .
Air Sampling Method & * D
^
Charcoal Tube
Sillo. Gel Tube Oustlmplnger _
Direct-Reading Instrument Detector Tube U ESP
Qas Sampling Bag^ Qaa Bubbler - Evacuated Flask ^
Tape Sampler O ther---------------* ' * * I ' T *
'*
Semple B u le (Circle One)
* y . *
*
**
; : vl - : B 1
Q - Management Raque* B _ Medical Department Raque*
D stlrty
"'
- Union Reque^Grievance
r . Subsequent to Regulatory Agency Study F-Research Q -G eneral Survey M - Employe Complelnt/Suggestlon
-- -
V jsrtehjif'Worte Station
..
012986
* 1
rl c.t !
SAMPLE ;.1
'.COMTAMINANT Total SwFber Fteeplrabie Dual
' ' l h .--1 .
Fume
W ....
.;
'
Smoke
- ...
Gai
Vapor
.
: MAJOR .
' .
A
,
e
' `
" '-'OTHER-
V / -.
... /;** ^ `. * V * - .At w i ( .
ir. -i-V
'*>*>?* '
.
`'
*
.
' `
,`v " w
: ./-S '
Air Sampling Device. Serial No.
. Fitter Type & S lia .
. -,Final Filler Weight
.tn llfa l Filter Welqht
. Pump Air Flow Rate Scale Reading: $trt
...Average Air Flow Rater .
------------- tltere/mlnuta
Sampling Time: Hapsed *
Start3 ^ 5 --------------
\
Stop \ C *
. Unit of Measure:
Sampled 3 0 3
utera
; Lattoratory ^ s p r i i ^ v m ^
CONTAMINANT BASE
CODE * 81 B2 ^
ANALYSIS MCG
;e v c u
:<: < 3 p o o
.
i* i
. 11t >r 1
1
:
1
1
11 1 1 r 11 1!
iti
1 tea.-,!.!! . 1 r 1 1- 1 ; 1 : ;
1, 1 1 1 1 -1__ I__ 1-- 1-- 1-- 1--
Engineering & Administrativ* Contrat*
FAC TOR
L
~ 'TEST
i ^ PERMISSIBLE
T
MEASUREMENT ,
~ LIMIT
LO ittiO O .* !
I; 1 . 1 -
r-. 1 1 ' r i 1 . "'<
* I''-
1 1 1 1 I I
1 1 1 ' r it"
t 1 '* 1
ft.
1 1 1 * - ( " v ' ' *
1 1 1 '* 1 T 1 -
Personal Protection
? ft r* ^ 3 ^ *
Other Potential Occu_p_ait.toPaMJtre_e__: ^"0n aNjoaSI aa
Heat Radiation " eiriwa'oIu/OSiirtr
__ T rDk f'VlhIbTi^^lson
SpItlBn
Comment.
3 Biological Ergonomic Illumination
* /n s
^industrial Hygtwtst
rMlnt.`Cd." "C D *R
e,. ----- .... . ' 1I. ,
'* *'
*.../ v|
012987
i
.
" '
'i`i,iij':*`i: *' ' . : r : .v*: !*. '' ' *
` . ' ' \.`cF,i|,*` ' - ``"j * 'ili1.- - ., .f . i
' *'
r
ilS :.! "
" ' -V..' . '. '
.,
'-Tri ' t*? *
SfcSwP-** :
Sj& FORD MOTOR COMPANY -------^ . employe health services -
:: rr: .^v -;:^^ !!NNDUU Ua TaF iUHAiL^L- 9^| El N ^. E .,1, ; . a ir a n a i^ s^ ^ :^ sheet
j
O . ^ r a i^ Dot* i- -
Roc Typo Sciuit
5 i]
UborMory Sample Ooatgnitlon & . Oita Ratiteyat Nr '" '
' ' , 'l= - v: ' - " " L .
1- lf t .0 ,0 ,0 ,0 5 } .
PlanAt EU/, S S .
1 ---.
v- \ j
lutldlng
'
------
Work Station Location
Shift [gO - . .Langth orWorV hi'
-
i
. -
-
Sim sU T y p l - ( hckB Z.a*:or SZ and US O.FD) ` ' r y S M A g g ^
, B t Braathlng Zona .'.. Sonanti A rar. .....Q S c u fC i
B Latiorawiy s.m p l. , 0 , W d Oitimdeaflen _ K
--------- --
AltSamplingMithod - B FHW .0 fte.pIr.bj.Ju.t
Charcoal T u t*
P siticiG elT utia
DlroctiReadlng t i w v u W D4' 0C,or =Q! . Qi.Samp,ling' B o fl^ -nU - fQina.* E" J"uDbt0ilIeBrr ,. .Evacuated B p a k . - ^ f i ^ . j --^ -
Tap Sampler D . 0\twr -- --- -- r ; * * * *
...............
gjHppl* Bm I (Circle One)
. .*
O - Managamant Raquaat r 8 - Followup Study
T - Medical oapartmant Raquant ; 0 - Unlan R . ^ . d Q
^n o ^
E - SUDsiausntio naglrv * e " n=v s,JJ,iy . * ataaic
0 - Q w . r a l Survey H- Employa Compteln./Suggaadon . - ^ 8 ^
, .
r`
' , ^ -I '
m -..`
...
J fe w .
l^orit'Statton ' ' ,-' ' '
012988
.. Mmp Air Bow Rate Seal Reading-. Start
,, ,,
. Average Air Row Rats.- ..
^ ____ ______
' r
t ys. ( -1 i---
_ . G l& D
SempHna Timer Slart -- --A--
--
stoa _ L Q i o S__l ____ Unit o t Me a s u ri^ l!: .
.. Elapsed Time: Laboratory
\ tC
minute. Air Volume Sampled
------mors'
'^1
' " J Oeto SubrorntriV ' " ' 5 ^ ! -
Engineering & Administrative C o n tro ls ^ D iiS
, C om m enti,
. ^ L L f a a . ' 'D ito '
O'VIbradSa a 0 Biological
d^ , f --
............. .
H Ergonomlo
....
,S W 5 g g c ^
-Industrial Hygienist
. Malm. Cd. c D "R '
01298G
. jysr n y . '
P iS i
,::V
kf.v. '
- ir - p
' ' viti
. ..
<v/-
I..... j'/iJ.V - u-*i`V
-:!,*.A-:-.'.'.**: / :
* *v.
'' :.' : >;^i-fSk<;V
: . j ':h : : U tV .-,
,! ''!<':'
i^Vi
"'Bii: ;
SS .-V'iMrtV.!'"*. *
;: :y~. y -
1'*^ 0;^ ..
; r1t mf f titt f*'!:.*
:t4: .-./ .V.'-* Vvi* .
-- -- ~ -------------- -----
; . - . u ' :< : r ? j .
'
FORD MOTOR COMPANY .........T v^T lN D ? T R I^ fe l. |; _ !
^ E M P L O Y E HEALTH SERVICES
A IR A K A ^ S
;
iv
.'.'V-V.
o i n gI ,'0B1 hZ X] D ito L - J ----- -- U L U J
v
(i ..d
Ree Tynpo .
Sou. k
IS S SJ
I L. LaabbooraratotoryryNN.0p; --; --- ------i '1'
'' -
' `
Simpl Deelaflitlon 1 L V . U . < f -- O . f J . i i
.DataRafatevalNo. .
/_;,Vr "\Z
. 3
J
--,
Department Work S tiilo n Location ,,
Work Operation
____ --------------------`
r f'i - ' r- " `
. j ..-^r . >>> ' ~ ^
\
? "3 ! ' 1 "
-m- '/ '*
1
LU d
' -- " ................ 1 I - 1.:K-,t::L:.iJ2xiiE
uM.amniuialaccltuurrttnnog -- I L U -- 1 1 1 1
1 ' "' `
i . - ' i - ______
Standard Nos i i r I-__1__ L U -- L
Production Roto:
M W * * * ' , a ^ w N o ...^ ,
: [El
Employe N i m U ........... V' l t
Ident No.. '. i' i
U: l
_ U . r tn - ......
^ ^?, T T-
`.. V''Sil/1Sf.S` /rS. ![?-.
^
; < .:v -
,-v. __ * - -
Job Title Shift. E -J
--' y C -'v
Lanoth otWork-smu
How*i."
P-* - " j
Hours/SWft
9 ^ 1, a Doy./Wek l5 ~ * ^ .at ttiH Job *''
;} i j b ' l
S am pli Type ' I P * * ' OA or SZ and LS orFO) .
v .
Breathing Zcfl. Q"er8l Are ' D Sou,CB ZOn' ; # ^ : . V ; S Laboratory Simple Field Oetcmlmtl<m , _
,,'.'j.-.'v: .
.
jv-. p . ..... ,
Air Sampling Method JlB Filter Respirable Du.tFUtw
* D Charcoal Tube
Tube-
Dlrect-R iadlnglnslium ent 0 Detector .Tube
U . . a , , sampling eag_. - Q . * 8ubbler - Evacuated
o Tape sampiar D Other,--- -- -- - - - "*
riA t& i-
...) , - f
':
" T '' ' ''' , . -
S jm ple Basle ICIrcla One)
Q V Management RoQuast B
C - uadleol Oeaartment Request
F - Subsequent to Relet<V *0V SluQV r " Q - Q e n . r ll survey . . H - Employ. ComptalnWSugga.Uon ,
______
`
""'
-|-` iM.ii -r .....
iS l^ rrr
' "- ,, ' L
|
*
012990
. *'.- * &<'J
r , . ....... -- '
-::lcib:--il" '
-- 1........ --
SAMPLE
COMTAMINANT
. .... '
Total Duat/FIber ` . ' Respinge Oust .
, - . Furti
' -'
Mlst
: ,
.
MAJOR
Smoka
Dal
I
Vapor
: . OTHER
.
`
fi' '
______ ____-- -- u ---------------------- --
'V :;-
Air Sampulingo Devvliccee_. u
Sari! K,o. m
. Filler Typa 4 Sito .
. Final FUter Walght------------- --------- :--------- ____ mg I
Olfl or once .
mg
.Infilai Filler WolgM------^-- " ................ ____ mg j
( " ------
_ mag)
_ Pomp Air Flow flato Scola Readlng: Start
S top-----
Avorege Air Flow Rai or Sampling Time.: -_Sta_rt-- l _
1\ * - -- -
llter/mtnuto
io : lo
- stop
^2
Unit of Measure
-V
.
k.
.Hopod T ! m e ::2 Z ^ E - -- L -- minute. Air Volume Sempied
Laboratory^. V tv A b v l
CONTAMINANT BASE
. CODE f Bt B "
ANALYSIS MCO
FAC TOR'
------ i ---------- -- Utero
Date M Submitted ls iil
' TEST MEASUREMENT
. -'.. PERMISSIBLE . ! >- LIMIT
0,0,1 ,-S,3ua,i <sjbco
I . I I 1..-L I I - I __ 1_
,,1....1__ I-- 1-- L I I I -L
t i i J __ I__ u
& o , g , 0 0 , 9 .3 .Q
I ` I ' I__ L
-L ii i - L !. -I.
I i I !' I M I 1I
J 1 ,1. j-c i: _i__ I-- L
V
! ' I - L i t
J __1-- L J __ L
<" ' 1
EnQlftoorinQ A AdirtinlutnitlVD Controle
< ,\ ,\ 1 ig g ^ ejW . d Porsonal Protection
r ^ n -? *_r,.--*, _**
t--__t -
' Other Potanti.! OccupatloSalkiaai : ^ o
D . V I ' 3 Biologico! 0 Ergonomie ' ' '
;
Haar Radiation 1S Cutena^s/OcuWr^ Santtitlon _ ' U Ulumlnotlon
.
.
'
' r ..... ,v W a . * . W S i p f & v* . - t o s * :
-W y
f.
-
Industrial Hyglaniai*5 ^ ' ^ ^ ^ ^ ^ ^ >
------
. Maint. Cd. C D R '
: ,V* a \\ .
012991
. ;.
.
V
t f i ' . ./V -.- ." ;-^i -
V-
---'.'' ^ ' '!. - 1' ^ -- :---- : "
- : "
, *".: '
<* >* -
--I ' ~
.........
't *
, ,
,
S S & T F O R D MOTOR COMPANY " rM > r u n , rtVC UHM Tw sph v iCES
J_ 4
- -
A- ^ INDUSTRIAL HYGIENE- :.
AIR ANALYSIS SAMPLING DATA- SHE
Date' 0 ^ 1
1 lO
' '
" . sogra
EE
, - ~ f, " >* 1 . , * . i 4>, ", ( . 1 ' )
,
fncsnLl SDam# plReeDtrajaevltainl entlqa,n &/ ' " y2* e - -- 1 0 . 0 P ' , g _lH A
Plant Dopartmnt Work Station Lopetion
......... - --. '4- -t- , '* ' . flayiColuran No. .
Work Operation.
.7 ^ . , ; 'i'ir* /;0.-; 4 - > ' / ' ^ ,
Mterlali/ewoductt/SuppIter
< >
`j.Tre,^ ni> K . W -rf |,viM-r
r - ti* < * * * / ? V-V-"1' * '
012992
012993
FORD MOTOR COMPANY
:'.V - -i
V
- - ' N . - rn/fy.-.?''*" '*
" : ' :
TM-TiNDUSTRi^Yp)|NI':;'7': - - :.;j
Qj3l 1 n '. Dor.1Ttm u n . L.aborat.oryN?:o"*_1-___ V
Date
-
;;__
" " 1 L... 1ST S g c a ^ n . B i a l l l e o n Q '^ s :
Work Station Location
-%
Work Oparatlort .
ft QwAj^vA
y
r i x ^ i -
^ 1
n-- ^
'
Manufacturing t i i i___i i i
Standard Nos, I r r I i-- L
.i-
V
H. I f!
i l'
"i iVtW'VuL-.ll-' ` `V i r
- '. '&<&'ff 31*v..''*.^ r fJ - l* | I
>v-w i - - ., \gh+r.
_Tl Raleut.Normfif vBatfti ` * ' ' .... ,'* f[ n
/ : .l ;;J
- . /< ; .
" ` * ` t
Langui,uf iwii.yL''. , i .... ---- <. ' ~ r ^ ,
Houra/Shlfl P .I.T '.O j j ' y^i1,V. i
-. ; . r L- fv-rt' ' . 1 i ^.Jn *
Semple Typa (CUackJZ, GA or SZ and LSa' n
._ _
BreathingZgpa '. H General Area . .
Uboratorysam pl. J D Raid Det.rmlnatlon_ ; .
^
VL. .>,
Ali S.ntP.10 Mathod. . . Charcoal Tuba . SllloaG Taba oirect-ReedlnoInetrumont OeUctorTuba^ Oaa Sampling 8ag . Gas Bubblar. Q Tapa Samptar D . OUiar _
' '''
, ,, , - *, i l
.
ila Baila ICIrcte One)
V
r j , Management Reguest B - Fotlow-dp Study -
Y - Madleal D.partm.nt fl_.gu.st ._ 0 E - Subaaquant fa flglaSfry Agancy Study F - .H " 1' Q - General Survay- H - Employa ComplalnUSuggesaan
i
1
1
.......... .i . - ......-.' --
_________. . . L - - ......... -- -- - ------------- -------
.. ,, . .`1 ^ ^
'e '- <-:~
- -
^
^
. .
**'-'
.. . ;
''!. ?>! -
---G '
h"* y --
012994
; ,
it
SAMPLE
COMTAMINANT Total Dust/FIbor
Resolrable Oust
Fuma
Mist
Smoke
Gas
Vapor
MAJOR
OTHER
.o
Air Sampllno Oavlce
Sartal No.
.filia r Typa & Siso _
.Final Filter W eight----------------------------------- . -- mg
. Initial Filiar Weight------_ -- -- ----------------
mg
Pump Air Row Rale Scala fli&dtog: - Start,
, Avorag Air Row Rota: Sampling Time: Start
fltera/mlnuta
Stop n : o 4
. Elapsed TimoA:
. mralas. AJr Volume Sampled
Oifiarenca .
( - ----
S lo p ____
Unit ol Measure. IlfoM '
mg .meo T
Laboratory --
CONTAMINANT - BASE
\ ----------
CODE g B1 02 p
ANALYSIS MC
FAC L TOR T
TEST
' .
MEASUREMENT
PERMISSIBLE - LIMIT
( \ Q , \ ,3 ,3 , ^ 1
,
i
i i i i i' i
* .I....l....l....-.-.-.-..1.-.-.-.-..r i iI
:< :
i i ' * * '' !
<?poo
.
4 /
. . I L o ;o ro ,c . 1, ^ ,o 1 ' 1 ' f 1 1
... 1 i - i i-
<
l- l 1 * 1 1' !
__ I l l ' l l __ !__ 1 1 1 ' 1__ I I .
- i - i * ' - . ' i :< ( 1 " 1' * - 1 1 t
!.. .1__ !__ 1-----1-- !-- 1-- `-- '-- Engineering A Administrative Conirolst
__ l _ j __ L _ !__ L _ i__ 1_ _ l J ,, . I
1 T .-l--
Personal Protection 0 , 1,
Other Potential Oceupettortai:6tM*! ".;C] Norte Heat Radiation \ P CulrnepslOpalar
Q-Vlbradon ,, P Biological B Ergono* Sanitation C Illumination
Comments.
''induitrfal'Hyfllenls
, Meint Cd. C D~ R
012995
012996
. ,, j - ' k l i i * . >JV * **** ' `
V ^ f r - ^ fr
;;-
'ilV i'/.-T .';
t-i' I SAMPLE ; .' COMt a m in a n t . / . 1. !
"*Vi *' '
v t-r
J?
TottfTDdsVFItiar
/ .
Respirable Oust
- '.
Fom* ' '
' C Mlst
:
Smoke
.
.
Gas
' '
Vapor
v MAJOR
-. ' v - V - '
, .
_ ' I " :V ' -V f -e ,e. **.* . V.-YA * '/*
"--------- L _
.*, ' -
. - 1 -
; \ j \ 'ti" C. . ... .',
.^ n i
- . . . ... *
'
t
' , ,,,, ' ^
...Serial Ho. ...'final Fter-Weight -- i'iririltlai Filter Weight --- ~ '
. Filter Type i Sire _
-'- '
-----------------1
- ma.
nnn .
. , Pump Air Flo* Rote Sosie Reading! -S ta rt----------- ----------
bltfereivca.
( - ----
stop____
. mg
S e ra g .A lrflo w R .t*
------------ ^ m i n u t a
.. I
' SSaammpplliinngg TUirmnee:, Time,
oSuta.r,.t T.-*P-- -----^- -------------------- -- Stop
. . .- ,
l ^
- ^ . A I r . y o lu m Sample
Unit of Meaeure zv
"" * ^
-< f
................ .. U J
^
Laboratory -
--V---^A.JV.vfjhu yr FVie a S f t K V
- Date Submitted^ ' -l V 1 & -- ____ J
: CONTAMINANT
'
. BASE
CODE 82 F
ANALYSIS
FAC L
-~ ~ TST '
- ^ . PERMISSIBLE `
. - ^ J.'-.UMIT
I
MCG
. . . .TOR . T
,
. MEASUREMENT ^ ,. . .. t>*,
'
,, . . .
. fv\JCiVJ\ r \t |3w i3"W, i^ ! o U 1 i, 41:,-- -- -------------
, -
.
1
1 1
' l ' - l - 1 1 T -----1---- --~ --
J
1
l
, l` ,
, ... I I 1 - 1 __ 1---- -|---- 1---- -1---- 1
.- 1 1 1 1 1 ; 1
!
1 I1 1__ 1-- 1L . ' '1 '! " ' -
. ------------------
Engineering 1 Administrative C o h t r o l s 'W S --------- '
L e ; o ' i , O t O r i . 1A . o 1 1
- 1 - 1 ! - * . 1- f l :- - ' r i r *
~1 * r -1
1 -I--l-' i 1 I-r i i' - * ' i '-'-i-'i .l L
i ' 'i * i 1 "
.~ . ... i:. .
i i ,i " ^ ' - l - ' T 1' *
t i ;j1 1 '-1--
* y T ri^ '.`fn > '
,oj:T "f-`
i
I I
oth er Potential Occupa.t.ional tiei...: `-rpl Njf.li?sea ' Qu wwbratlftn , D Biol-ougical B Ergonomie
I
O Heat D Radtatlon iD c trtp n o o ^ iO c H la r santaJoii J Illumination < ; .. .
? k*i ^4.';^. -
. . Comments
* 0 - ~s -V -
' *
__________ _ _ _ _ _ _____ :-- 1 I
--
...
.T 1 1--
i M P i r a ' l S A1' -i.Vh* , *
.*..*Vi1! /"
* ` **
ji.
'
------ `'ndu'atril'Hyglenlet Z
*~C D __
*1 *'*'! ' "' 1 * .' ..
ir'C'" V*,';".V,
.. v
012997
- : : - v ' i . - ^ v - ' --.^
;r ...........
: `: - \ .'.v.! ' # ' - !' - '
- ; 'V j- ;^ : V".; -.!';:/ '::';;^ rL.: -
.
:
: ... . . `
y
:
.. ; . .`V ::-r-h-i .
'
;
-
-- 1
. '
:
. ';. .'.'.' :t:f -..' ... i:iV. . . - , .v- ' '
:
:
v _
; ;
t ' ` ' '
- ..
UYf>'V> '
-
_ _ FORD MOTOR COMPANY ................ V' .;-|NDUSTRIAL.t)YGlENr:H
^ -E M P L O Y E HEALTH SERVICES ... AIR ANALYSIS SAMPLING DATA SHEET ;
. "\
V -'
IP l\^
Date
. " TVP*
' n(
^Sourfe IS 1
i ^
^ I v I e GVv A T k V i s
Ol.nt ! g lJ S f c g d
Deoartmen.t IRV I ST / I yT 1o 1rIBn r i =*m >
laDrtinry no.
----
-- -- ------- --
^ ' = " e " l . r i o n i 3 X V S T t o . Q . Q . O ' t H i l - ..
fU r^ c *
.... f V , r ,,;
. -
,
Running ` ------------------------ ------- r '
':.
`i 1
| '
Bay/Column No. -- 1-- 1-- i-- 1-- 1--
Work Station Location --------------------- --
. - -------Wfk Op^tlOp
-- - .........-
MatGriots/fly'PfcdtfC^SupDllffs--- -
* "- .` r
' '. .-.
. 0 .......... .
!
' ..' :'v ! :: : r . ' * . . `I- r .
' v', ,,'.. ,i i ,
^ ' . ' .;
' .
J.' ' M > , '
ut*.
l
7
.--V - - , , . ....
; -a.,
Monulaciuring V ! -
I l . _ l __ L
Standard Not. _-J-- L_J-- 1--j-i-- 1-- J L -- ------------- -- -
( I - t - - i ; . : i : : . : i . : .--L - i >--i-ii
I I I k ' ~ | - i i ' I*- I ' .-.`V
_
r,
-
--;, _ ; aV " ' r qTVq
L P r o d u c tio n * ^ Norm* Above N o rn * Q
jM *.,
'...; .T
V S H S E 3 E I E 1 - , v A r p & K ; i . sS . - . !'i : '
- I A ' - . V1 -
- -I
job Tltla Shi ... HourslShUt
m oLanQtlt
a
l.W i
ork Shift _ paysiWaak
D '! ^ .Hour'
Y i& fY to
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Santola Typa Check B r OA or SZ and tS o fF p ) O Breathing Zone. __0 General Area.......... L Laboratory Sample Field Determination
Sample Baal* IClrcto One)
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-
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ft^Maoagement fitdUB.t 8 - Follow p Study ,.
i Medical Department Request D - Union f la f -
E - S'uubbsweqquuaernrt lto Regulatory Ag9ons'Vy StWu'ciyy ... . !JF? ~- Roa^irch .^.Viii^.io^/erV,^
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*o - Qenoral Survey aHt - nE_m__p.il.io.My. ZC^ iemon lAnln i/ S^U fl o l n t / S u g g o a t t o . r ~ . _
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-
012998
Air Sampling Device
Serial No. -Final Filter Weight -- .---- -- -----------------------
1
- ' - ....... D tfle re n c a _ _ _-
- - mg
; "
Initial Filter Weight----------------------------------. Pump Air Row Ante Seale Reading: Start _
.. . .......- - <. jh-."
I
. Average Air Flow Rate: _ -- ----------- --
nure/mlnuti
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j
i V. -U n it of Mm iw -
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Sampling Time: Start -------- ~
" .
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,,B apied Time:--------- * * *
' Laboratory
CONTAMINANT BASE
CODE * Bt B2
Y ? J X Siampl* 1
analysis mco
FAC TOR
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` .-Date 2 Submltti i ? L 5 S ^ '
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. MEASUREMENT {..,,` y
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Engineering & Administrative C o n t r o l i ^ ^ L .
Pareenal Protection P A lV ! ^ .
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Other Potential Occupational Stressi D Nofie
neat Radiation Cuttneellsracuhir
Comments.
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"Ihdustrfil Hygienist
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012999
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^ :F0B"D MOTOR COMPANY
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Data
I n 1n1 X'** 1 nec Type ,Ql 1nhnmtom Nn.
------- !------ -------------------- -----------
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Sample Designation A 'T'yt> r -- D , Q
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Sure s
Data Retrieval No. ... f e i l i a j J .
Building.
E S iM B -S y s s k A ^ .
. Bay/Column No. _J__ L -11. L
Work Station Location
----------------------------
.
r Work Operation ----------- ----------- :------ --
:
... '
------------------
-
.
Materlals/erProducts/Suppllert----------------- -- --------- ----
----
--
Manufacturing
Standard Nos.
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.
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production Rot' H ^
f~I Above Normal - Balow Nomta. ' < * - - =
a , , , . aTMma V Lad 3 >>L^J - ^
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Shift I*23 Hours/Shlft
\P^'M . i L_J **-tWsJob : Lonoth o( Work SWH. ' t V --- .Hours
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- ' ' rar - 7 ^1
OayJ/Waak
SempleType '- (Check BZl A o r S Z and LS orjTO s"
'
Breathing Zona General Are .... Source Zona 4 -
` t8 UDoratory Sample . Field OaUmdrutlan . ,
AhSamplingMethod niter RespiteOuatFitter -
Charcoal Tuba ' Silica Gal Tub. O OuMlmglnger .....
oirect-ReadlngTiulrumenf ' Detector Tuba U ESP
O Qae Sampling Bag fl^ B u W e r . ^ a c u a te d R e a k -..
rS
Tapa Sampler 0 h e r ^ > V t T 3 ---- T ~ ^ "
'
" ' ,,.l , , l oa * r O
0.0 \
Sample Be.le (Circle One)
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I a S Management Regueat - B -.Follow-op Study
-
::;.i ~i V - Medical department Repeat 0 - Union, R w .aU O riev.nc.
E _ subeaquetd to Reijal.foiy' Agerey Study F - Rejeerch
Q general Survey ..H - Employe ComplelntlSuggeatlon --------
IdDNV.KS^ * ^ i s
- rSketendf.Wdrk Station
013000