Document nRD9MgV49QJQQNy63prLvZ1

s I. r; Xw *b. . *, Iv* < 1 f > Job no. -v:; i .w "V V* i , .y \ *\ 'r .J , i ci '-t * ` r v-` 17 '* 1 (i i l- < * w 0^ VCM Epidemiological Study - Individual Work History Form A - Workers known to be alive 1. Date of birth 0 2 o T ? 2. Date hired r* 2- ^ " / Status: 3 . Now employed O / ~ 2> 4 . Retired (give dace) 5 Terminated (give date) 6. If retired or terminated , please state how you know that this man is alive. 3J (/> Oo CO 0> CO 03 f Job history with estimated exposure Title Check estimate^ exposure in ppm ^50 50-199 -200-500 >500 from to & 'h ^ L-tf from J* 'ZH to ft: 5.2 7 1 from f> -..o' i to 3'SJi from to 8-t^L ) r;'' * from to <6-^1 from 2'6 7, to i - from 9- o ?, ' to ( O ~ 0 6 z. JErana^ 6-16-52 6-30-5 3 1-14-5 1 =25=5 jR----------- 1-6-51 7-5-5 1 --71----h-6--e- ;c 3-5-5 S . 1- 3-1;-. 57 p>`# 1655-131 Drver Operator Saren V1V2 Pit. Ccntr. Art. If tf If ; Sinned T'osted .iob Sinned -posted .iob Contr. Art.` Contr. A^r. II loan.Hold.Tan 1: 3-. Wheel Onr. " (t Polvr.er Operator M 11 It II II tl ". 1 COnJ*.. * Contr. Anr. II ..... t! II H 11 " Contr. A.nr. ft 11 HIRED P _ *ME CHANCED LEFT 3-3-5cj 6-16-5. \ p"j _ 1,, ,, " > 9-1563 3-2~5c - 2-27-61 EMPLOYMENT RECORD REASON | CLCCK NO.| OCCUPATION Ccntr. Acr. Sicncd posted iob " i -M- , ".'T'O Sinned posted joe Contr. Ar:r. v . A "r. Contr. Anr. 1 >55-13" Polvr.er Operator 11 Janitor Handvmsn t\ l' c I T.'. j. p \ ; c r 1 ' c' r -1 c 0 r II Jani tor-iir.nayr.-.an tl II Tl T* ir IT 1 OEPA 4--V_`_ff._*_ ___ Saran VI72 p]t. 1! 11 It t M; 03-05-62iC3-UA-63 CCNTR RAT CHG 03-C 5-6.' : C -i-'-C- f. 5 11 1 SARAH V1V2 I-- H ANJ Yi'iAN C t - a 3--yi;03--0^--63 i-i I 5 C R 6 C of. 0 CH G 1 1 i OK Id A 1- CaNT UP Ci-CA-fcii 1 l-C7-cc CONTR RATc CHG III S Ar Ah V . Va 0 3 --'6 -- 63' rs-rs-t t - 6--' i -- t i 1 11 ^ ISC -.CCJXG CFG ' 1 1 GRIak CaiHT OP 3L. .,Uk/P ACK aGLR.. Cb-C^-od ; I I-iT i-6 3 : I SC HlCJAC LFG.I1 ;COA^uLaTk 11" 4 I - 6 3 : 3-.. 9 - 6 6 ! N1 SC A 6 CO A 0 Ch G! 11 'COAGULATOR UPe. R 03-C9-SAIC3-- Ce -- to! CCNTR t* A T a CHG Si 11 ;CCAGolATOK U P c k C3-C7-'*4 CON T A k A T e CHGr ' i-\! CCai.ui .. T C A fiPr'-R 03-C7-^C. i0-'t-dO! C r k r A.T d CFG 10-26-cfc, 11-07-ccl F.iJ.C. SUPL -1 1 *v 7"6c!l2-51-cd!KcC Ti< A-7'S3-cR 11 . C _ ->GU l ' 1 OR ..Lilit R 11 ICOnGuLATQK O^tR 13 j STOCK pRuCV_ 3J _1_ 1 -vNIrq0 ; 01-1 7-t /i v'^* 10 1 L C A tJ l C h C C K c r 0 1 " - /"^X/ 0 i - c ~ - c / 1 im>C Rl'-JnC CHG 11 isF pFirl ^IK CL CO V* jC K 'J U CKG|IL sk shift. 5rs . 7 yt C N T k P 4 T G CFG 1 !A ! SR -5h 1PT1'' S7n CL 1' : 1 S C .Cai_U. ;*< ft S T STOCK C L K of\ L LK o ID O ID CUG!i1 CHG j II HAST 3 T *0 l. K C LK CHG11i SR tOLl rT STK CL- ;; Ai 1 Si ut i\ L LK Sk sj i i j- r s r (s. c u PAST STK CK-OcN Z A J.j 3 Tj\ -- G cll'L j `i o i \~ r j vi i';ut IV X *' i CK~r aU