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Attachment I <br /> SLATE OF CALIFORNIA George DeukmejLan, Governor <br /> nEoAAIA"FNI�Of INDLISIRIAL RELATIONS <br /> DIVISION OF OCCUPATIONAL SAFETY AND <br /> HEALTH ADMINISTRATION <br /> 5-5 GOLDEN GAVE AVENUE <br /> A1+ IAANCISCO ADDRESS REKY TO <br /> P O BOX ew" <br /> SAM FRANCISCO CALF 94 to 1 <br /> CARCINOGEN REGISTRATION FORM <br />' Dear Sir <br /> This letter may serve as a registration for carcinogen use in accordance with Title 8,California Administrative Code, <br /> Sections (as listed below), indicating use of the following carcinogenls). Check the substances that are used in your <br /> workplace, or potentially could be -handled in an IT workplace. <br />' 52118 5210 <br /> X Asbestos Y-- Vinyl chloride <br />' 5209 5211 <br /> X 2 - acetylaminofluorene <br /> Coke oven emissions <br /> X 4 - aminodiphenyl 5212 <br /> X Benzidine and its salts X t, 2 - dibrorno--3 - chloropropene DBCP <br /> X Bis (chloromethyl) ether 5213 <br />' X <br /> 3. 3" - dichiorobenzidine and its sans x Acrylonitrile <br /> X4 - dimethylaminoazobenzene 5214 <br /> X <br /> Beta - naphthylamine X Inorganic arsenic <br />' x <br /> _ N•nitrosodimethylamine 5215 <br /> X X <br /> _ Beta-propiolactone 4, 4' - Methylene bis 12 Chloroaniline) MBOCA <br /> X Methyl chloromethyl ether 5219 <br /> _X_ Alpha-naphthylamine X Ethylene dibromide (EDB) <br /> X <br /> Ethyleneimine 5220 <br /> X __ 4 -- Nitrobiphenyl X Ethylene Oxide (EtO) <br /> Other- <br /> Continued on reverse side CAL/OSNA tag <br /> April 190 <br />