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ABERDEEN CHEMICAL PLANT-DOSIMETRY RECORD
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N 9 001332
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S6cial Security No.;Job Code
Instrument
HAZARD VCM Lead Total Dust
___ Time ?-`^_AM(M PM( )
AM(*-)PM( )
Airflow_______________
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-PPM o
--M^ograms/M0 '
--Milligrams/M'*
__________________ Samnle Tima W >"
PEL:
--Micrograms/M^
Analyst Analysis Date
)Hazard: VCM ( ) Lead { ) Dust ( ) (
N 001332
1. I came to work atAM ( ) 2. I left work at -------------------------- AM ( )
PM ( ) PM { )
Firewatch Work? Yes / No (Circle One)
3. I did the regular work of a (enter Job Class)________
4. I used a respirator during the following jobs (check one)
Non*
Dust Mask
Alr-Un* Rwp.
Scott Alr-Pik
3M Air KUt
5. The following unusual events may have caused me to be overexposed:
6. Other comments ?nd information (Use reverse side of card)
Signature_________________________________ Please complete and return to Guard