Document x50kM8KmpYwVBb40KoMG4G7YQ
DO 0 7 5 9 2 0
ONFTDFNTTAl
o
INDUSTRIAL HYGIENE SAMPLE CONCENTRATION DATA ENTRY
E OF INVESTIGATOR :
*1 & * Ce
MICAL NAME
.:. 0//v m ____________ _DR#____
NT_____ ________________________________ PLANT NO. _ Af/9/
TLS DATE ` HMDDYY >
.
RLE NUMBER
FLING TIME IN MIN. .RLE VOLUME IN LITERS iF'LE TYPE (A, S OR P) A-AREA
S=SH0E7 TERM
F^RERSOMAL AREA, I ESCRIBE
r I RATER TYPE ' 1 TO 7.)#
jrfT
/<-U'C^Z & - \
H "
_ ~~
^ )
"""HI / wf 7\ /' r/< \
L> ) Cj ' / ' / j ;
5= / :::::::::::::::::::: /
-
^J' '/v - .7
"lcyee i'.d" no.
JCS ASSIGNMENT #
S^jSfsTJJfSSJSSSS.'l
/G/
^/ /
RLE CONCENTRATION RESULTLlIJz_____________________
^"V "' ^
r
R TYPE 1 LL RACE
NOT USED
2 = MOUTH-BIT 3 - HALF FACE
5 - AIR LINE
6 - DUST MASK
7 - SCBA
'HIE: 10? TIIEl: ' ______ LOGINNING TLCW RATE: LOSING FLOVI RATE:
DO 070901 CONF TDENT TAl
INDUSTRIAL HYGIENE SAMPLE CONCENTRATION DATA ENTRY
NAME OF INVESTIGATOR'.
__ )
CHEMICAL NAME___________________ _ ______________ D**_______
PLANT ____
<*PLANT NO. L2Ll!L
SAMPLE DATE <MMDDYY)
SAMPLE NUMBER
SAMPLING TIME IN MIN.
,.z3l;jZ-_____
SAMPLE VOLUME IN LITERS
SAMPLE TYPE (A,S OR P)
A=AREA
SSHORT TERM
P-PERSONAL IF AREA, DESCRIBE
S
RESPIRATOR TYPE <1 TO 7,.):*:
S' OR ID HOUR SHIFT
SHIFT i, 2. OR 3 EMPLOYEE I.D. NO. IH JOB ASSIGNMENT *
------*L2-12LL_________ _f2d--
SAMPLE CONCENTRATION RESULT
2,9
COMMENTS:
RESPIRATOR TYPE: 1 = NOT USED
2 - MOUTH-BIT 3 = HALF FACE
JLL rACE
5 - AIR LINE
6 = OUST MASK
7 SCBA
RAW DATA:
START TIME: STOP TIME: BEGINNING FLOW RATE: ENDING FLOW RATE: _ "------------
00 07B9PP OONFTOFNTTAl
INDUSTRIAL HYGIENE SAMPLE CONCENTRATION DATA ENTRY
E Sr INVESTIGATOR:
/H \ ^l)
: ;cal name
____ _______________ dr#_^_/
NT ^Is&XU^LSrPLANT NO. OMtQJ
^UJ LlJ til ill
DATE CMMDDYY) NUMBER NG TINE IN MIN. VOLUME IN LITERS TYFE t.A,S OR P) A"AREA S^-SHORT TERMM ER TONAL ;-RA, OESC :TSE
E i. I TO 1, ) %
:;H IFT . F ' , S, UNV 1>
NO. :ENT 4*
C4-0 2.-87
<r _ ^SLJLlSoJtzA____________
rRATION RESULT __________ SL--Z___________
' U--l. b ACw
NOT USED S = AIR LINE
MOUTH-BIT 3 = HALF FACE
6 = OUST MASK
7 - SCBA
b L'-iz
^
bIRSING FLOW RATE:
or\:oc floi; rate:
no 07S9R3 CONFTDFNTTAl
INDUSTRIAL HYGIENE SAMPLE CONCENTRATION DATA ENTRY
]- INVESTIGATOR:
<8 fi -
e-r.)
: al name____________________________________ _____ --------------------------------------------- PLANT NO.
OMk)J
E DATE u-lMDDYY)
o 3 -xr~ JT7
E NU; .DER
ING TIME IN MIN.
E VOLUME IN LITERS
E TYPE <: A , S OR P) A" :CfA. .
-SXF\7 TEuM "'EM DUAL
S_
-.A, DESCRIBE Y-.TDR TYPE <. 1 TQ 7, ) *
7i:
! 2 PCUR SHIFT
` ', 2, OR 3
IV EE I.D. NO. IS AI SIGN; iENT ft
-itJ-JL:i2--
__________ _________
SC CCYCENTRATION RESULT
*
-IRATOR TYPE: 1 = NOT USED
r= -ULL PACE
S = AIR LINE
MOUTH-BIT 3 = HALF FACE
6 = DUST MASK
7 " SCBA
ST -IT TIKE: -,Cr TILE: rCYlITCIEG ELDVJ RATE: ETDIaG TICK RATE:
DO 075924 CONFTDFNTIAl
INDUSTRIAL HYGIENE SAMPLE CONCENTRATION DATA ENTRY
E OF investigator:
-Cd-fio rfo
HI CAL NAME____YS^jM.______________________ DR
NT____At&SJ&Sz.________________ PLANT NO.
fl t
RLE DATEJ.MMDDYY) RLE NUMBER pling tike in min. ?LE VOLUME IN LITERS ?LE TYPE CA.S OR P) A-AREA I'-SrlCRT TERM
-"EES DUAL .1A , I ESCRIBE
:p:fatcr type <1 TO 7..) * L HOUR SHIFT
: ', E. OR 3 - _SYEE 7.D. NO.
GNKENT #
-oZ-ir/S-?--
_r
____ 3L3-*-Ll__________
___________ ea
EN'RATION RESULT
JL7 &
ErrInATQE TYPE: 1 -- NOT USED
- - full face
5 = AIR LINE
MOUTH-BIT 3 = HALF FACE
S = DUST MASK
7 - SCBA
rUSINCING FLOW RATE: LIDIIIC FLOE RATE:
DO 075975 CONE TDFNTT A1
INDUSTRIAL HYGIENE SAMPLE CONCENTRATION DATA ENTRY
E Qr INVESTIGATOR; -Jz-'Sj.
EM I CAL NAME V OM~ ~ ~ ' DR#_~ ott-t*_
ANT_____________________________________ PLANT NO.
MALE DATE (MMDDYY h?le number I CLING TIME IN MIN. MALE VOLUME IN LITERS MPLE TYPE (A , S OR P)
A=AREA ** r.u/ \ In.RM
c-='-'ERSONAL : -REA, DEECRIEE
tratcr type <. i to 7,)* ON ;D HOUR SHIFT . I FT 1 , 1, QR S RLQYEE i.d. no. - .JLE ASSIGNMENT #
_r
S'
ZZZzZZ2ZZ2.*JZZZZZZZ
L3L
."LSI CONCENTRATION RESULT ____ _________ L
r HTQR TYCE1 1 = NOT USED
2 = MOUTH-BIT 3 * HALF FACE
- FULL RACE
5 = AIR LINE
6 .= OUST MASK
7 - SCBA
LTCDEUIl.G FLOW RATE: LIES FLOY RATE:
DO 0759?6 OONFTDFNTTAl
INDUSTRIAL HYGIENE SAMPLE CONCENTRATION DATA ENTRY
iE OF INVESTIGATOR: __C________
ENICAL NAME____)L&&1DR#_~ off**-
ANT _MxL*._PLANT NO.
' .RLE DATE < MMDDYY ) ;PLE NUMBER MPLING TIME IN MIN. : iFLE VOLUME IN LITERS . ,PLE TYPE CA,S OR P)
A=AREA S--SHORT TERM
PERSONAL V-.EA, DESCRIBE
ATCS TYPE < 1 TO 7,)T CR i 2 HOUR SHIFT -FT I , 2, OR 3
EE I.D. NO. JSC ASSIGNMENT ft
. ",_E CONCENTRATION RESULT
NOT USED 5 = AIR LINE
MOUTH-BIT -3 = HALF FACE
6 = DUST MASK
7 - SCBA
FLC2? RAIE: RATE:
DO 075977 CONF TDFNT TA1.
INDUSTRIAL HYGIENE SAMPLE CONCENTRATION DATA ENTRY
: OP INVESTIGATOR:
QjSfJk&k____
,ICAL NAME --iLL _________________ DR#
<T
_____
PLANT NO.
pm p /
~'LE DATE <! MMDDYY *'LE NUMBER
G TINE IN MIN. VOLUME IN LITERS 'LE TYRE (. A , S OR P) A AREA
IRT ,RM
EZCCR I EE .R TYRE '1 TO
-EUR SHIFT
E, OR 3
:.D. NO.
SI SNMENT #
7,.)
-c.: TRATICN RESULT
c
'W-* _ 31
?.Y
1 ' U' -:TES TYPE: i = NOT USED
= -U_3._ PACE
5 = AIR LINE
MOUTH-BIT 3 HALF FACE
6 = DUST MASK
7 - SCBA
Eli DESEEDING TLO" RATE; CEDING ELOW RATE:
DO 0759P8 OONFTDFNTTAl
INDUSTRIAL HYGIENE SAMPLE CONCENTRATION DATA ENTRY
'.E Op INVESTIGATOR:
____
INI CAL NAME_____ lZ_C_/^lDR#____ OJLlJf---L!Ll-
ANTPLANT NO. J3L&1
..RLE DATE Ml iDDYY > .RLE NUMBER ...SLING TINE IN MIN.
K.RLE VOLUME IN LITERS .RLE TYPE IA, S OR P) A- AREA S"SHORT TERM
l4LzZl7
IAEA, DESCRIBE T.-IRATCR TYRE i. 1 TO 7,:>*
;l hour shift
TLCYEE I.D. NQ. 103 YES.GNNENT #
____ I2JU
ALE CONCENTRATION RESULT______________ LzjL
MI^IRATCR TYPE: I = NOT USED
= PULL :rACE
5 = AIR LINE
MOUTH-BIT 3 - HALF FACE
S = DUST MASK
7 - SCBA
I.TAP.T TTIEl: SID? TILE: LSCTNNIEG FLOW RATE: D.Tinc- FLOW RATE:
DO 07R979 CONFTDFNTTAl
INDUSTRIAL HYGIENE SAMPLE CONCENTRATION DATA ENTRY
INVEST I GATOR :
jJsL-
TM,,JJ LL.-J1pHI CAL NAME___ _____________________________
j
NT PLANT NO. P Wp /
-'LE CATE c, MMDDYY > ?i_E NUMBER
J-uaZzZL-
sPLINS TIME IN MIN.
RLE VOLUME IN LITERS
i?LE TYPE (A, S OR P) A~AREA
S-SHORT TERM P=PERSQNAL
_______________ ________
AREA. DESCRIBE R:-"'ATCR TYPE '.1 TQ 7 A ;D HOUR SHIFT
ZIIIIIIIiSZEIIZI
F" , 2, OR S LCYEE :.D. NO. JOB ASSIGNMENT #
iiizeeee_iase::::::
T:_E CONCENTRATION RESULT
/H. 3
ES'IRATDR TYPE: 1 = NOT l..'SED
2 = MOUTH-BIT 3 = HALF FACE
; = SLu. FACE
5 = AIR LINE
6 = OUST MASK
7 - SCBA
&-HT TIILC: lEICIING FLOW RATE;
;,:V_NG CLOW RATE;
DO 075930 CONFTDFNT TA(
INDUSTRIAL HYGIENE SAMPLE CONCENTRATION DATA ENTRY
EOF INVESTIGATOR;
)</"
F.ICAL NAME
V_Ld____________________ d**C&A1JLL
NT ,,fc^LfefcLiyLi.PLANT NO. .&JYU&L
'.RLE DATE t. I1MDDYV '.) RLE NUMBER FLING TIME IN MIN. FLE VOLUME IN LITERS EVE TYPE i.A,S OR P > O'" TRSA S=SHORT TERM R--ERB2NAL
CEECKIEE -OEhi OR TYPE (. 1 TO 7.) fc ;0 FOUR SHIFT
i .0, OR 2 ,: -EE :. i:. no .
:A E 'O 17 NKENT #
?.:ZSlr.fZ.
'ZZilTXTiZ
QJL.
..0 CONCENTRATION RESULT
/
. l.. . = NOT USED
2 = MOUTH-BIT 3 = HALF FACE
RACE
5 = AIR LINE
S DUST MASK
7 - SCBA
iT T" ' ` 7
0LEV TOME: ~ ' rlow rate:
OILS i LCR RATE;
oo 07F,931ta, conftdfnttai
INDUSTRIAL HYGIENE SAMPLE CONCENTRATION DATA ENTRY
investigator:
YIICAL NAME _
- _M
__ DR# ___________ plant no.
&*7
&___
T'LE DATE (. MMDDYY )
Q6-X3-X7
=LIN3 TIME IN MIN.
-LE VOLUME IN LITERS =LE TYPE <'.A,S OR P) ".-'REA I-SHORT TERN
--PERSONAL
-'PE-'-., DESCRIBE .-I"ATOR TYPE (1 TO 7.A* R C HOUR SHIFT
FT i, D, OR 3
_;yee i.d. no.
f IS.GHRENT #
""
_____________ O_____________
_________________ __________ I_
""
__
. _E CDVCENTRATION RESULT _________ __________________
Or-LEA,OR TYPE: 1 = NOT USED
~ TUs-L FACE
5 = AIR LIME
MOUTH-BIT 3 HALF FACE
S = DUST MASK
7 - SCBA
71 j? TILS: IDSIMMIMG FLOW RATE: rcriMG FLOW PATE:
00 075933 CONFTDFNTTAl
INDUSTRIAL HYGIENE SAMPLE CONCENTRATION DATA ENTRY
I CF INVESTIGATOR:
h)
L2jL_I CAL NAi-iE_____ )l.C,M.L.___________ VTM,,Q.1JJLZ
plant no. jDlI-
r-LE DATE < MMDDYY > FLE NUMcER PLING TINE IN MIN. RLE VOLUME IN LITERS --LE TYPE CA.S OR P) A"AREA S-SNORT TERN
F^fEPOCHAL ~~P. , SET OR I EE
.-IT A. " CR type U TO 7,,).+'. : r.SUR SHIFT
,.r
jYEE 1 . D . NO . :o h.ssi g.HmEnt #
.jSv-;
ITRATICN RESULT__________ EL__________
YPE: 1 = NOT USED
PACE
S = AIR LINE
MOUTH-SIT 3 = HALF FACE
S = DUST MASK
7 - SCBA
,NG TLOL RATE: 100" RATE:
00 075934 OONFTDFNTTAl
INDUSTRIAL HYGIENE SAMPLE CONCENTRATION DATA ENTRY
OF INVESTIGATOR:
XZMICttL MftME ____kL_/lL/_____________________ DR#_ CL>4 *
________________ PLANT NO.
SAMPLE DATE (MMDDYY ) SO'. iPLE NUMBER SAMPLING TIME IN MIN. SAMPLE VOLUME IN LITERS SAMPLE TYPE <.A,S OR P >
z' - r- CCT ^
vSHOPT TERM -PERSONAL -ZA, DESCRIBE I "'AT OR TYPE U TO
ID HOUR SHIFT ~ i, 2, OR 3 EYES I.D. NO. 03 ASSIGNMENT #
7,)T
STRATION RESULT
AS
:.S=:-Y~SR TYPE: 1 = NOT USED
- = PULL PACE
5 = AIR LINE
MOUTH-BIT 3 = HALF FACE
6 = DUST MASK
7 - SCBA
FOGLMiMG FLOW RATE: 0103IMG FLOW RATE:
DO 075935 CONFTDFNTTAl
INDUSTRIAL HYGIENE SAMPLE CONCENTRATION DATA ENTRY
NANI CF INVESTIGATOR CHEMICAL NAME ________ Y_C^1_____________DRtt
O/W n$>6
-L.ANT
__,v,_______________ PLANT NO. gAf^/
SAMPLE DATE CMMDDYY') I.,. '.RLE NUNEER 7 .N .FLING TIME IN MIN.
SAMPLE VOLUME IN LITERS SA iRLE TYPE <A,S OR P)
A-AREA S---S.-ORT TERM
DESCRIEE
^-atgr type i 1 to
I L HASP. SHIFT
s-:;7" i ,
dr 3
.PPLSYEG 1 . D . NO.
I". CSS ASSIGNMENT #
7,)*
QZu&ZL
.1
IE
iizJ2irjzi.
----------------- ***--
NTRATION RESULT
TYRE: 1 = NOT USED
L PACE
5 = AIR LINE
MOUTH-BIT 3 HALF FACE
S = DUST MASK
7 - SCBA
T-UlLZ :^L IIT.I'S FLOW RATE: ilj. cLui? RATE:
00 075936 OONFTRRnt1 Al
INDUSTRIAL HYGIENE SAMPLE CONCENTRATION DATA ENTRY
IVESTIGATOR! :al name ._____ V.C.t31_________________ dr*
IT ..L71&*xjj&j,._________
PLANT NO.
(XLJ)
<?n f V 114..
r LE DATE MMDDYY RLE NUMBER -LING TIME IN MIN. RLE VOLUME IN LITERS RLE TYPE (A, S OR P) --AREA Y - SHEET TERM
0_Z_33-J-Z S_
-'REA, DESCRIBE .. f.AECR TYPE '."i TO
- D HOUR SHIFT E" ' , L, OR 3 _OYEZ I.D. NO. i-L assignment #
7> ,M:
DEI
____`i3.JJiJ.it
RATION RESULT
/
TYPE: 1 = NOT USED
RACE
5 = AIR LINE
MOUTH-BIT 3 = HALF FACE
S = DUST MASK
7 * SCBA
1 --j ITCIIITDIIG rlOi'l RATE: DICING FLOU RATE:
00 075937 CONFTDFNTTAl
INDUSTRIAL HYGIENE SAMPLE CONCENTRATION DATA ENTRY
E OF INVEST IGATI ;mical name
PLANT NQ.
RLE DATE *. MMDDYY > PuE NUMBER SRuPLING TIME IN MIN. SAMPLE VOLUME IN LITERS S LISLE TYPE A, S OR P) c~AREA S.---SHORT TERM ""-PERSONAL AREA, DESCRIBE - r F 1 RAT OR TYPE ',1 TO 7-.>* 1 OP' IS HOUR SHIFT F-N.PT I , 2, OR S _.LOYEE I . D . NQ. ; jOO ASSIGNMENT #
z/icJl2
~
_ "
__ "____ ~ IIIII____ I _I_II____ 212-111
-.'..RLE CONCENTRATION RESULT________
NOT USED 5 = AIR LINE
MOUTH-BIT 3 HALF FACE
6 = DUST MASK
7 - SCBA
DO 07593B CONFIDFNTTAL
INDUSTRIAL HYGIENE SAMPLE CONCENTRATION DATA ENTRY
I'ALE OF INVESTIGATOR
CHEMICAL NAME
________ dr#__
PLANT____/VfgCV^/>? C-PLANT NO.
M&1
s.'ciple date :nmddyy:i EM.RLE NUMBER SNNPLING TIME IN MIN. SAMPLE VOLUME IN LITERS SAMPLE TYPE <A,S OR P)
A-AREA S-SHORT TERM P=R'ERSONAL IF AREA, DESCRIBE RCIFSEATCR TYPE U TO 7-.)*: : DR iD HOUR SHIFT 1 .ITT 1, 2, OR 3 ,, LCVEE I . D. NO. ID DCS ASSIGNMENT #
s:
____ ^
~JULJL2-.J__________ 4J2
` RLE CONCENTRATION RESULT _________ __________________
ES-IRDTCE TYPE: 1 = NOT i JSED
2 MOUTH-BIT 3 = HALF FACE
= -DLL FACE
5 = AIR LINE
6 = DUST MASK
7 - SCBA
IID.C FlCW RATE: i rooi: rate:
DO 075939 00NFIDFNTTA1
INDUSTRIAL HYGIENE SAMPLE CONCENTRATION DATA ENTRY
E Li- INVESTIGATOR: _ MI CAL NAME_________________________ DR
-NT____jhd&JZJZjS*.______________ PLANT NO.
^
L)> l!l H ill U! '
DATE i. MMDDYY ) NUMBER
NG TIME IN MIN. VOLUME IN LITERS
TYPE (. A , S OR P)
-U^JIzJLJLJLZ--
"____r
"_
"
M-'ORT Tti.YM
DA, DESCRIES ~^7DE TYPE < i TQ : D HRUR SHIFT
;. D, OR 3
'.'EE I . D . NO . I ASSIGNMENT $
70 T
TEATION RESULT
_s
~Zl
________ LA___
jLLu
NOT USED 5 = AIR LINE
MOUTH-BIT 3 * HALF FACE
S m OUST MASK
7 - SCBA
'V'" * Hih"7 Vii"*t LDD-iDFDFG FLOW RATE: DDEINC FLOW RATE:
DO 075940 CONFTDFNTTAl
INDUSTRIAL HYGIENE SAMPLE CONCENTRATION DATA ENTRY
" INVESTIGATOR: AL NAME
J / ?} __DR#_ ..onjtLLJ^A.
_____________________________________ PLANT NO. _^2AdLlQJ
DATE (.rv.'iDDYY) NUMBER NG TIME IN MIN. VOLUME IN LITERS TYPE CA,S OR P) EA "PORT TERM
-'EPS ON;-L OA, DESCRIBE -. TOR TYRE '.1 TO 7,j* ' 0 HOUR SHIFT
, 0\ OR 3
/EE.'s1sisD.:mNeOnt. #
/~
"
"
<-- _ _ _ --J
~i~t _" ~"
::::::::zz::::::_"_
E CONCENTRATION RESULT
' L <"*v
,"r,j t.o YPE: FULL ACE
NOT USED S = AIR LINE
MOUTH-BIT 3 = HALF FACE
6 = DUST MASK
7 - SCBA
'T- i V ~ 1 X^ioL * iV? T1Ti,'4Tl"W*' 4
7.ZHTMVZ FLOW RATE:
now rate:
DO 075941 CONFTDFNTTAl,
industrial hygiene sample concentration data entry
NAME OF INVESTI GATOR : CHEMICAL NAME __ PLANT
__ C
____ dr PLANT NO.
<<T
OI
_____
SAMPLE DATE i. MMDDYY SAMPLE NUMBER SAMPLING TIME IN MIN.
SAMPLE VOLUME IN LITERS SAMPLE TYPE <A,S OR p)
A=AREA
S=SHORT TERM
P-PERSQNAL IF AREA, DESCRIBE
RESPIRATOR TYPE i. 1 TO 7,)* S OR 12 HOUR SHIFT
SHIFT i, 2, OR 3
EMPLOYEE I.D. NO. IH JOB ASSIGNMENT #
QLjzJJLzJLL <5
IIsZ'-IIIIII--
SAMPLE CONCENTRATION RESULT
/ =-? -
COMMENTS;
'RESPIRATOR TYPE: 1 = NOT USED
2 = MOUTH-BIT 3 HALF FACE
4 = FULL FACE
5 = AIR LINE
S = DUST MASK
7 - SCBA
RAW DATA:
START TIME:; STOP TIME: BEGINNING FLOW RATE: ENDING FLOW RATE:
DO 07594? CONFIDENT TAl
INDUSTRIAL HYGIENE SAMPLE CONCENTRATION DATA ENTRY
NAME OF INVESTIGATOR:
__ C^e v-e.
chemical name AIiv/IaAIzzisIl__________vm __j2JAfAzAlLjA__
PLANT _/Z$Z-1-LLA-J2-LSl21JSL PLANT NO. &LlJA.1
SAMPLE DATE MMDDYY > SAMPLE NUMEER SAMPLING TIME IN MIN. SAMPLE VOLUME IN LITERS SAMPLE TYPE CA,S OR P)
A=AREA S=SHORT TERM
P=PERSONAL IF AREA, DESCRIBE RESPIRATOR TYPE < 1 TO 7,').*: S' OR ID HOUR SHIFT
SHIFT 1, 2. OR 3
EMPLOYEE I.D. NO. IH JOB ASSIGNMENT #
L-lJLL^JLZL __ _________________________
SAMPLE CONCENTRATION RESULT
/ 2 /z
COMMENTS:
^RESPIRATOR TYPE'. 1 = NOT USED
2 = MOUTH-BIT 3 -- HALF FACE
4 = FULL FACE
5 AIR LINE
6 ** OUST MASK
7 - SCBA
RAW DATA:
START TIME: STOP TIME: BEGINNING FLOW RATE: ENDING FLOW RATE:
DO 075943 CONFTOFNTT AL
INDUSTRIAL HYGIENE SAMPLE CONCENTRATION DATA ENTRY
NAME OF INVESTIGATOR:
^ 7-
CHEMICAL NAME
_____________________ DR
PLANT _Z^lQj_iU-.PLANT NO.__ &3j2J
SAMPLE DATE <. MMDDYYOJ / .
SAMPLE NUMEER
SAMPLING TIME IN MIN.
SAMPLE VOLUME IN LITERS
_
SAMPLE TYPE CA,S OR P)
A=AREA
S=SHQRT TERM
P=PERSONAL
IF AREA. DESCRIEE
"
RESPIRATOR TYPE < 1 TO 7,)* ~
~
8 OR 10 HOUR SHIFT
_
SHIFT , 2. OR 3
_
EMPLOYEE I . D. NQ.
IH -JOB ASSIGNMENT #
/' / "
~ _
SAMPLE CONCENTRATION RESULT
COMMENTS;
^RESPIRATOR TYPE: 1 = NOT USED
2 = MOUTH-BIT 3 * HALF FACE
4 = FULL FACE
5 = AIR LINE
6 DUST MASK
7 - SCBA
RAW DATA:
START TIME: STOP TIME: BEGINNING FLOW RATE: ENDING FLOW RATE:
00 07R944 CONFTDFNTTAl
INDUSTRIAL HYGIENE SAMPLE CONCENTRATION DATA ENTRY
NAME OF INVESTIGATOR: ^T)r
CHEMICAL NAME______ J_j.__
PPLLAANNTT -Mi*.
___________
DRW_Q.LlJi.__ L3-S.JZ-.
____PLANT NO.
_\]
AMPLE DATE (MMDDYY) SAMPLE NUMBER SAMPLING TIME IN MIN. SAMPLE VOLUME IN LITERS SAMPLE TYPE i.A,S OR P>
A=AREA S*SHORT TERM P*PERSONAL IF AREA, DESCRIBE RESPIRATOR TYPE < 1 TO 7.)* 3 OR ID HOUR SHIFT SHIFT I, 2, OR 3 EMPLOYEE I . D . NO . IH JOB ASSIGNMENT #
LLz-2Jl=-Z2-- __ "
__ ~~~ " ~
"" "
_
_ "
f"
SAMPLE CONCENTRATION RESULT
COMMENTS:
^RESPIRATOR TYPE: 1 = NOT USED
2 = MOUTH-BIT 3 = HALF FACE
4 = FULL FACE
5 = AIR LINE
6 *= DUST MASK
7 - SCBA
RAW DATA:
START TIME: STOP TIME: BEGINNING FLOW RATE: ENDING FLOW RATE:
OO 075945 CONFIDENT T Al
industrial hygiene sample concentration data entry
NAME OF CHEMICAL PLANT
AMPLE DATE < MMDDYY SAMPLE NUMBER SAMPLING TIME IN MIN. SAMPLE VOLUME IN LITERS SAMPLE TYPE C A,S OR P)
A=AREA S=SHORT TERM
P=PERSONAL IF AREA, DESCRIEE RESPIRATOR TYPE <1 TO 7,.>* 8 OR 10 HOUR SHIFT SHIFT I, I, OR : EMPLOYEE I.D. NO. IH -JOB ASSIGNMENT #
~
_
~ ~~
__ ~
SAMPLE CONCENTRATION RESULT
COMMENTS:_________________________
^RESPIRATOR TYPE: 1 4 = FULL FACE
RAW DATA:
NOT USED 5 = AIR LINE
START TIME*. STOP TIME: BEGINNING FLOW RATE: ENDING FLOW RATE:
MOUTH-BIT 3 * HALF FACE
6 = DUST MASK
7 - SCBA
DO 075946 C0NFTDENTTA1
SAMPLE DATE CMMDDYY) SAMPLE NUMBER SAMPLING TIME IN MIN. SAMPLE VOLUME IN LITERS SAMPLE TYPE (A,S OR P)
A=AREA S=*SHORT TERM P*PERSONAL IF AREA, DESCRIBE RESPIRATOR TYPE < 1 TO 7,;*
8 OR ID HOUR SHIFT SHIFT I, 2, OR 3 EMPLOYEE I . D. NO. IH -JOB ASSIGNMENT #
7^-Jx j ~J?
" "
__ _
"
"~ _
^ ___
"
~
SAMPLE CONCENTRATION RESULT
'1U '
COMMENTS;
meSPIRfiTOR TYPE: , = not USED
2 . mouth-bit 3 . HALF face
JLU . ACE
5 a AIR LINE
S DUST MASK
7 - SCBA
RAW DATA:
START TIME: STOP TIME:
BEGINNING FLOW RATE: ENDING FLOW RATE: _---------------
DO 075947 CONFIDENTIAL
INDUSTRIAL HYGIENE SAMPLE CONCENTRATION DATA ENTRY
NAME OF INVESTIGATOR:
V.CM 1 ?LJ3JZ LCHEMICAL NAME I '*
1
jzj_________ _____ DR#.
j
PLANT_____ _______________________________ PLANT NO.
SAMPLE DATE CMMDDYY) SAMPLE NUMBER SAMPLING TIME IN MIN. SAMPLE VOLUME IN LITERS SAMPLE TYPE IA,S OR P>
A=AREA S=SHORT TERM P*PERSONAL IF AREA, DESCRIBE RESPIRATOR TYPE U TO 7,) * 3 OR 12 HOUR SHIFT SHIFT i, 2, OR 3 EMPLOYEE I.D. NO. IH JOB ASSIGNMENT #
SAMPLE CONCENTRATION RESULT
7
______ Q3L_______
COMMENTS:
^RESPIRATOR TYPE: 1 = NOT USED
2 * MOUTH-BIT 3 HALF FACE
JLL .-ACE
5 = AIR LINE
6 * DUST MASK
7 - SCBA
RAW DATA:
START TIME: STOP TIME:
BEGINNING FLOW RATE: ENDING FLOW RATE: ---------------
no 07B94B
INDUSTRIAL HYGIENE SAMPLE CONCENTRATION DATA ENTRY
/T r-
NAME OF INVESTIGATOR:
,/vr 7: /' cn-cn)
V OA1___CHEMICAL NAME .
________ DR
PLANT
~ PLANT NO. jXJ2j2J
SAMPLE DATE <. MMDDYY '.> SAMPLE NUMBER SAMPLING TIME IN MIN.
SAMPLE VOLUME IN LITERS SAMPLE TYPE <.'A,S OR P)
A=AREA SeSHDRT TERM
P-PERSONAL IF AREA, DESCRIBE RESPIRATOR TYPE < 1 TD 7,.):*: S OR 10 HOUR SHIFT SHIFT 1, 2, OR S EMPLOYEE I . D . NO . IH JOB ASSIGNMENT #
O3 --
~~ ~
""
^ __ ->
' "" ~
?
~
2
SAMPLE CONCENTRATION RESULT_____________________________
COMMENTS:
tFlESPJRATOR TVPE: 1 = NOT USED
2 = MOUTH-BIT 3 = HALF FACE
JLL , ACE
5 * AIR LINE
6 * DUST MASK
7 - SCBA
RAW DATA:
START TIME:
STOP TIME:
"
BEGINNING FLOW RATE:
ENDING FLOW RATE: ~
------
DO 075949 CONFIDENT! At
INDUSTRIAL HYGIENE SAMPLE CONCENTRATION DATA ENTRY
NAME OF INVESTIGATOR: ^1
CHEMICAL NNAAMMEE____
PLANT______ j.lJ-2-X-LLJ.
DRtt P //f 7J ____ PLPALNATNTNONO. . Off/j /
SAMPLE DATE CMMDDYY) SAMPLE NUMBER SAMPLING TIME IN MIN. SAMPLE VOLUME IN LITERS SAMPLE TYPE <! A, S OR P)
a=area SSHORT TERM P*PERSONAL IF AREA, DESCRIBE RESPIRATOR TYPE (1 TO 7,'L* 3 OR ID HOUR SHIFT SHIFT i, 2. OR 3 EMPLOYEE I.D. NO. IH JOB ASSIGNMENT #
r , r r/
__ _"
< _^ "
ITM-"l?&Z
SAMPLE CONCENTRATION RESULT
.
COMMENTS:
^RESPIRATOR TYPE: 1 4 = FULL FACE
RAW DATA:
NOT USED
2 = MOUTH-BIT 3 = HALF FACE
5 = AIR LINE
6 OUST MASK
7 - SCBA
START TIME: STOP TIME: BEGINNING FLOW RATE: ENDING FLOW RATE:
DO 075950 OONFTDFNTTAl
INDUSTRIAL HYGIENE SAMPLE CONCENTRATION DATA ENTRY
NAME OF INVESTIGATOR: CHEMICAL NAME PLANT
DR# PLANT NO.
C /t
b'J/
?&
SAMPLE NUMBER SAMPLING TIME IN MIN. SAMPLE VOLUME IN LITERS SAMPLE TYPE <A,S OR P)
A=AREA S-SHQRT TERM P*PERSONAL IF AREA, DESCRIBE RESPIRATOR TYPE <1 TO 7.)* S OR 10 HOUR SHIFT
SHIFT I, 2, OR 3
EMPLOYEE I . D NO . IH -JOB ASSIGNMENT #
SAMPLE CONCENTRATION RESULT
COMMENTS:________________________
'"RESPIRATOR TYPE: 1 4 = FULL FACE
RAW DATA:
NOT USED 5 - AIR LINE
START TIME: STOP TIME: BEGINNING FLOW RATE: ENDING FLOW RATE:
MOUTH-BIT 3 - HALF FACE
6 = DUST MASK
7 - SCBA
DO 075951 C0NFTDFNTTA1
INDUSTRIAL HYGIENE SAMPLE CONCENTRATION DATA ENTRY
NAME OF INVESTIGATOR:
\ *> *
CHEMICAL NAME____________________________________DR#__ fl f f
/_
r PLANTu________ ______________ _____________ PLANT NO.
^s-1 ^` *--' ' '
SAMPLE DATE U1MDDYY) SAMPLE NUMBER SAMPLING TIME IN MIN. SAMPLE VOLUME IN LITERS SAMPLE TYPE CA,S OR P5
A*AREA S^SHORT TERM
P*PERSONAL IF AREA, DESCRIBE
RESPIRATOR TYPE (.1 TO 7.)# 3 OR 1C HOUR SHIFT SHIFT I, 2, OR 3 EMPLOYEE I . D . NO. IH -JOB ASSIGNMENT #
"" ________ ____
SAMPLE CONCENTRATION RESULT
COMMENTS;
^RESPIRATOR TYPE: 1 = NOT USED
2 = MOUTH-BIT 3 = HALF FACE
JLL . ACE
5 = AIR LINE
S * OUST MASK
7 * SCBA
RAW DATA:
START TIME: STOP TIME: BEGINNING FLOW RATE: ENDING FLOW RATE: ~-------------
00 07FSPP CONFTDFNTTAl
INDUSTRIAL HYGIENE SAMPLE CONCENTRATION DATA ENTRY
NAME OF INVESTIGATOR.*
CHEMICAL NAME
PLANT
!
______
zl'-'u. _ (ft?-. /
PLANT NO.
l)l
SAMPLE DATE < MMDDYY > SAMPLE NUMBER
IIII^ --IOs*-- ^'.7
SAMPLING TIME IN MIN. SAMPLE VOLUME IN LITERS
I_ II
I
SAMPLE TYPE CA,S OR P)
A=AREA
S=SHORT TERM
--
P=PERSONAL
__
IF AREA, DESCRIEE
~_Z~Z~Z IPESFIRATQR TYPE <. 1 TO 7,).*
_
S OR IS HOUR SHIFT SHIFT 1, 2, OR 3
_
ZJZZZ~Z _
EMPLOYEE I . D . NO . IH JOB ASSIGNMENT tt
~_r7~_
ZZJZZZZZZZZZZZZZZZZZ
s' SAMPLE CONCENTRATION RESULT____________ ________________
COMMENTS:
'.RESPIRATOR TYPE: 1 * NOT USED
2 = MOUTH-BIT 3 = HALF FACE
4 = FULL FACE
5 = AIR LINE
S *= OUST MASK
7 - SCBA
RAW DATA:
START TIME: STOP TIME: BEGINNING FLOW RATE: ENDING FLOW RATE:
DO 075953
confiofnttai
INDUSTRIAL HYGIENE SAMPLE CONCENTRATION DATA ENTRY
NAME OF INVESTIGATOR:
/
CHEMICAL NAME
PLANT
PLANT NO.
'^5/
SAMPLE DATE (MMDDYY) SAMPLE NUMBER SAMPLING TIME IN MIN. SAMPLE VOLUME IN LITERS SAMPLE TYPE (A,S OR P)
A=AREA S**SHORT TERM
P*PERSONAL IF AREA, DESCRIBE RESFIRATOR TYPE <1 TO 7.)T 3 OR ID HOUR SHIFT SHIFT i, 2, OR 3 EMPLOYEE I . D. NO. IH JOB ASSIGNMENT #
^ / 7_ "" I
" _~" ~
SAMPLE CONCENTRATION RESULT
COMMENTS:
^RESPIRATOR TYPE: I = NOT USED
2 * MOUTH-BIT 3 HALF FACE
4 = FULL FACE
5 = AIR LINE
S = DUST MASK
7 - SCBA
RAW DATA:
START TIME: STOP TIME: BEGINNING FLOW RATE: ENDING FLOW RATE: ____
DO 075954
conftdfnttai
INDUSTRIAL HYGIENE SAMPLE CONCENTRATION DATA ENTRY
NAME OF INVESTIGATOR:
__ ___________ _____________
CHEMICAL NAME PLANT__ PLANT NO.
_________________
& M/ : /
SAMPLE DATE <' MMDDYY .1 SAMPLE NUMBER SAMPLING TIME IN MIN. SAMPLE VOLUME IN LITERS SAMPLE TYPE CA,S OR P)
A=AREA S"SHORT TERM P*PERSONAL IF AREA, GESCRIEE RESPIRATOR TYPE < 1 TO 7->.$ 3 OR 12 HOUR SHIFT SHIFT 1, 2. OR 3 EMPLOYEE I.D. NO. IH JOB ASSIGNMENT #
& 3 V/-.?/'
=
'
r-' "''
SAMPLE CONCENTRATION RESULT
C '.
COMMENTS;
^RESPIRATOR TYPE: 1 = NOT USED
2 = MOUTH-BIT 3 = HALF FACE
4 = FULL FACE
5 = AIR LINE
6 DUST MASK
7 - SCBA
RAW DATA:
START TIME: STOP TIME: BEGINNING FLOW RATE: ENDING FLOW RATE: _
DO 075955 CONFTDFNTTAl
INDUSTRIAL HYGIENE SAMPLE CONCENTRATION DATA ENTRY
NAME OF INVESTIGATOR: CHEMICAL NAME______ PLANT_____ _______________
_____ ________ PLANT NO.
SAMPLE DATE (. MMDDYY > SAMPLE NUMBER
SAMPLING TIME IN MIN. SAMPLE VOLUME IN LITERS SAMPLE TYPE (A,S OR P)
A*AREA SSHORT TERM
P*PERSONAL IF AREA, DESCRIBE
RESPIRATOR TYPE UTO 7,.>* S OR ID HOUR SHIFT SHIFT I , 2, OR 3 EMPLOYEE I . D . NO .
IH JOB ASSIGNMENT #
__ 5" '
~ ZJZJUT
"
_ _"
JZZZZ-Z-ZZZZZ
~
____" ~__ "
ZZZZZZZZZZJZrZ
SAMPLE CONCENTRATION RESULT______________
COMMENTS:
^RESPIRATOR TYPE: 1 = NOT USED
2 - MOUTH-BIT 3 * HALF FACE
4 = FULL FACE
S = AIR LINE
6 OUST MASK
7 - SCBA
RAW DATA:
START TIME: STOP TIME: BEGINNING FLOW RATE: ENDING FLOW RATE:
DO 07S95ft CONF TDFNTTAL