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M cn10Q0c) <br /> F• (o = 1Zv <br /> CD <br /> o 0rnop <br /> O <br /> TI � ON N <br /> O C N o <br /> Q <br /> 0 0 <br /> M - <br /> = cQ CD <br /> U) m <br /> Eyewash Ft-.;un Se,vice and Inspection Record J <br /> w <br /> 0 <br /> 1, Unit LocatioM <br /> n•. <br /> W <br /> CD <br /> y -- 0 <br /> s 77 <br /> Unit Type: ❑ Perm anent Plumbing <br /> ❑ Pot .,.e ❑Other: 3 <br /> N <br /> t � <br /> E ewashUnit Service.Re•.or`; <br /> Date Solution was Expiration Date of Name of In�h riduallCom an <br /> Performin This Service (n <br /> Last Chan ed Solution 1 l ( <br /> r <br /> r <br /> Ll <br /> e <br /> Inspector's Initials below indicate unit's condition meets the following criteria: <br /> 1.Unit is clean and fully accessible in the event of emergency(there is nu debris product blocking access to unit) <br /> 2.Unit is full of solution to meet minimum flow rate of 15 minutes(portable units only) _ <br /> 3.Soluton within unit is not expired per the last entry on the service record above(portable units only) <br /> 4.Service valve is in the OPEN position to allow continuous flow of water to unit(permanent plumbing units only) <br /> 5.Physiraf flow test indicates unit functions properly(permanently plumbed units only) <br /> Eyewash Station Weekly Inspection Record <br /> Date of r Ite:it Date of Date of Date of <br /> Inspection Initials inapecHon Initials Inspection Initials Inspection I '' is Inspection Initials <br /> 3 t �� <br /> y 3�� r ` <br /> It dy0 C CD <br /> �i! S <br /> 1� y/i r+z j '3 / f N T <br /> by 1 7/ / �J o <br /> C CO <br /> .3 1' <br /> IG/rr�13 / �J71r?QJ j f ��/ ' �l j o cn <br /> C,) <br /> 57��// rn <br /> N I i � <br /> _ w <br /> L _ 41, ► <br />