Document oMB5g29rzQ20e3ErmGgxMb3Q7

ABQW50jB**r' ABERDEEN CHEMICAL PLANT-DOSIMETRY RECORD N ~ 001431 QiO co^fK- sHrO- ccWftit&gK __ Shift-. DM. U-IO-U Instrument No. esbJ Sdcial Security No. Job Code Time Start___________________________ Stop _____ AM{ JPMtfT) -JlllL____ AM(T)PM< J Airflow HAZARD VCM Lead Total Dust ^fcllSBSPJWffl0N U-^7 -ppM --Micrograms/M --Milligrams/M^ Sample Time PEL: ' --Micrograms/M^ Analyst^ Analvlis Date^//' // Hazard: VCM ( ) Lead ( ) Dust ( } ( } N9 001431 1. I came to work atAM { ) 2. I left work at -------------------------- AM ( ) PM ( ) PM ( | Firewatch Work? Yes / No (Circle One) 3.1 did the regular work of a (enter Job Class)________ 4. I used a respirator during the following jobs (check one) None Dust Mask Alr-Llna Rasp. Scott Alr-Pak 9M Air Hat 5. The following unusual events may have caused me to be overexposed: 6. Other comments end information (Use reverse side of card) Signature_________________________________ Please complete and return to Guard