Laserfiche WebLink
4r Li0agCA <br /> R 0S5> ^ec� <br /> Personal Toxic Substance Exposure Record <br /> + Substances not considered or suspected <br /> to .be a cancer risk at this time may be <br /> defined as a carcinogen at a later date. <br /> `' ' Cancer and cancer-related diseases may <br /> APR "."'fiake 5-25 years to develop in humans . <br /> 'RONMEWTAL TWj viduals exposed during duty should <br /> 'ERMIT/SERVI ocument specifically any suspected or <br /> known exposure within twenty- <br /> nd mail to: <br /> Public Health Services of San Joaquin County <br /> Environmental Health Division <br /> P.O. Box 2009 <br /> Stockton, CA 95201 <br /> (209) 468-3422 <br /> Name Axe �` ✓/ l � � � <br /> Agency/_ �' )l�� <br /> Assignment <br /> Date of Exposure September 12 , 1989 <br /> Location (or best escription) <br /> Co-workers on-the-s ene N/'Al-e- <br /> Response Number (Ye r/File) <br /> Type of Material: <br /> Name �O '"V <br /> D.O.T. <br /> Form: Liquid owder GranulesFog a Mist Smoke <br /> Describe how you we a exposed: Skin espirat� Ingestion <br /> Amount <br /> Details <br /> Approximate length f exposure c. x�✓��t��. <br /> On scene monitoring, lab or "Haz Cat's findings: /!'2 j <br /> Physician (If treated Name/,ate Seen <br /> Name! <br /> r ,/)Tilt. <br /> Address/Phone <br /> Ty a of treatm nt /��rrfi ✓1 % .`� .� J� �•�'-C'� 2r, ��P� ���j <br /> Misc Details: <br /> EH 22 020 <br />