Document ppOZJ39wNzLJrXrOgN88VZ16
FILE NAME Insulators Workers Comp Claims IWC
DATE 1968 DOC IWC077
OCUMENT DESCRIPTION Hallmark Stanley - Worker's Comp Claim
re)
ome ono ens
f de
oe,
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GOOD CAUSE APPEARING The applic son kerala
i when of clantv
RECEIVED
Department of Industrial Relaciono
Division of tadustrisi Accidma
Workmen's Compensation Appeals Board
State of California
WAY 16 968
FILED
FILED Cice CALLANS a fadie ed Acctante CALLANS Cice
... ... ... taaemneo ade
eet ee
...
...
...
APPLICATION FOR ADJUDICATION OF CLAIM
CASE NO
and ve ipje and z~tajef^ssigne~ original and ple esplet print addreads drs ese se
Ooh
'
.
OAX 26794
Anchor 36
Drive
Dele Califorais N uar qu y e
Pittsbury Califorais
_ Jacial Security No.
:
b prabudt evil w 1 "
qowneeree &apaean
.
eis
et al
a
Sce Ed^'bitA for list of and couriers and
employers
other zaon
els as soem at ESTO tote mde
r
a Oy dada band
pe tatere ate rte ae r nae
Turon hdd at CrPTen bndnet asaa OF OF OO
r
:
i
.
t
IT IS CLAIMED THAT 1. The injured employes bun
om
eee sane
__varioue deto 170 1943
__varioue
coe _ varioue __varioue
otek
ee while complaqu^'n^n InsulatInsuloatorrasbaestsosbateassbestots -o-- svockEv_ ockE_
asutas asutas variou
to prezent as variou
asutas uniary bring tut
eecemen
lunra
ad pnd io the cournt od cingleyPuat Instalation
A insulating volte an du come havd
Installation of insulating 3. The injury metuired us fallonu _.,
insulating
insulating asterial
cewees oe Tag OF
asterial including including including
.
chester
1. Accelgo Accelgo es sime of injury were
Seo Schiti
Schiti Schiti :
= Social
Security Sobe~ ule_of_ Sobe~ ule_of_ va ja
Social mm Security she she she fiyat va va
one
-
SEYASS of
3, Tr LE
LE
LE
ee
LE WEEK Decuperioral emt
Decuperioral
Decuperioral kind
some
ONLYONLYOTW 269
dut
art
Decuperioral
Decuperioral disease Cazonde. lnene=y 4. The injury showed Kubilay a fellowDecuperioral Decuperioral DeDcuepecriourapler8ioral Fe Decuperioral Decuperioral disease disease disease disease disease Enroomn e Gyat O2 pas Remmrewmene vy 60 stad GetEY -,
LD 6)
en
Campinative 1. Campinative we % 1. Ka~ uinsizlik
emapeny
CO eal
provided te paid for by employer at inarrance company Decet at
prid an x 1
i.
ettaa? a
am~-11 set targ 8s targ
177
[eld
ins eet
All TISCHES Wue fuenicha~ by the employer na landsson
Wa Fecesd ae
-
alee yart d et d Logo for
sche
schetrasmet wat provided n^ puit ar by
_ applicant
ee
sendi
applicant applicant aplicant applicant dramas ye emnme poe sample sendi
im
was travm^travm^ n^ motitived for this an"neyan"ney set ome
Other quam~-kete bene kled for ite~ ustrialinjurime this mapleyer fablemen Clack Berkeley California Dijeshil^>nyDijeshil^>ny benedicu me innen suceived siman the d^ af injury injury . W.
Cooper
K.D. 1 Seren.
) omavakvomito omavakvomito omavakvomito omavakvomito omavakvomito omavakvomito omavakvomito f^banking
Coper Cooper ,~ Means | Means Doug Doug Doug 200 Free Dijeshil^>ny aid te
Cam uansion
- a
7. Unumpisfocurando
Vaemployment
Cam uansion by
=o
n^
SE Nana Nana
y
Nana red Puceye pan sort edi Pate
.
. .
upp^/tkas heating and await of the same and all appropriate beme a provided ee
in flat because of a disa persvoegnsaedisng fubiley_fon Temporary
-8 This application sl^>biv^vodomnityum vodomnityum
Keinkennes
for
sandies
expensesniti
Madical
tratmani
Specily
the other
upp^/tkasvaquerat a
oakland 240 Leandro _ Kasting required at
awn
Dread on
OS aes)
Ko AuditoryJ~ drowityPerasame dia Compundation 12 proper redd
law
California 18 9_7_
omed
_ STANLEY 2. Number of withgate
Prestial winged -
imer
a
:
Estimated tiene al ai
Two hourE
_SHAIR_2 _SHAIR_2 _SHAIR_2 AYNUR__by_STEPHEN AYNUR__by_STEPHEN AYNUR__by_STEPHEN Y. CHEVALLA CHEVALA Ma ^ 199w
220_Juana 220_Juana Avenup San Coll now Sol
Sex Laser an weirtas ska man
Leandro
Coked Avenup ALLZANONE ALZANONE ALLZANONE NONE P^ dt + Leandro '
483-2446
\
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9321-56 Policy pue 3/15 . / PolicyPolicy 9321-5693221-56
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record Rincon California 9/30/56
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19-102-12 Employers 19-102-12 Policy 67-68 67-68
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IndustrialIndustrialIndustrialIndustrialIndustrialEmployersIndemityInEdmepmloiyteyrs 56-58 Policy
EmeryvileArmstrong
Cork *AUuoD Lancaster and
StretsSrets 3/157 Tavelrs prior 1/53 2673804 3/157*A3TOREeD 53-58 Policy Strets 3/1/57 r9-9/ No 19-02-1 APE OW BUISWT/T Travelrs Travelers
to 1 67-68
Policy RUB 2673804
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sadotug Insulations SouvINsrT9-6S/t
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es/t/L 9/t/6
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