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# 1 '1 q <br /> t 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 /> take 5-25 years to develop in humans . <br /> APR 27T"i' <br /> EIN1AL F-�_Tndividuals exposed during duty should <br /> ��N ,document specifically any suspected or <br /> ''known exposure within twenty-four (24) <br /> <br /> Public Health Services of San Joaquin County <br /> Environmental Health Division <br /> P.O. Box 2009 <br /> Stockton, CA 95201 <br /> <br /> Name '. A lC, -r ct�i e 4z 1)c pHWe:Ll 0 _3.X <br /> Agency l , c - �� •t 3 �u 1��:�r. l� Stu �' <br /> Assignment 3 , z ; <br /> Date of Exposure September 12 1989 <br /> Location (or best description) U.2 0C r Ci�uKC c^�-�' (�� ��d�c {� -• {l <br /> -TS <br /> Co-workers on-the-s' ene (1_� ��� ,u _ h , , 1 $e <br /> Response Number (Ye:r/File) <br /> Type of Material: <br /> Namev\\0 <br /> D.O.T. <br /> Form: Liquid Powder Granules Fog Ga ----Mist Smoke <br /> Describe how you wee exposed: Skin Respirat y, Ingestion <br /> Amount <br /> Details ',A �,; v n ;n <br /> CA V <br /> Approximate length of exposure C <br /> On scene monitoring lab or "Haz Cat" findings: <br /> Physician (If treated) Name/Date Seen pg _ RAPPAP(1RT q/121Rq <br /> Address/Phone CURRENT ADDRESS 840 S . Fairmont Ave . , Lodi , CA 333 - 1751 <br /> \ <br /> Type of, treatm nt .� <br /> Ck k 5 Y-,a.Iced . <br /> Misc Details: 7r. ;a a 2, V,\02CA , <br /> EH 22 020 <br />