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� �atrnta� � EMERGENCY EYEWASH AND SAFETY SHOWER INSPECTIONS <br /> A. Eyewash and/or Shower Stations {i. e. plumbed units) <br /> Station ID# Weekly Flow Test ( Initial ) Accessible ? Comments <br /> I3sy I IL C"'a" Week 1 Week 2 I Week3 V YN <br /> acamit. FrArw%. Week 4f Week 5 <br /> Week l Week 2JL. Week3 /' 1, N <br /> Week V Week <br /> WeeklNf Week 2 Week3 <br /> Week 4N1 Week 5 _ N <br /> Week 1 _ Week 2 Week3 _ Y / N <br /> Week 4 Week 5 <br /> Week 1 _ Week _ Week3 _ Y / N <br /> Week4 _ Week 5 _ <br /> B. Portable Eyewash Units (i. e. solution filled units or saline eyewash units) <br /> Filled with Caps/Seals Expiration <br /> Unit ID# Solution? l tact? Accessible? Date Comments/Deficiencies <br /> AO Y / N Y N Y iN <br /> WAj � w Y N �/ N Y ON fie_ 20W <br /> C w� nN f v'�' N <br /> f <br /> Y / N Y / N Y / N M m <br /> Y / N Y / N Y / N M <br /> Y / N Y / N Y / N <br /> Inspector's Name Inspector' s Signature Date <br /> Retail Facility . Inspections Ver. 1 <br />