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V <br />0 <br />Action 20. a. ®Send Letter b- Date Letter Sent: c. Date Response <br />2. pl. <br />22. Inspection manned? <br />11 yes, <br />Yes 0 No Priority: <br />2 23 to (N <br />I Transfer to (Name): <br />25. Transfer to (Category): <br />D Federal OSHA/Reporting ID <br />L_ _j <br />b, 0 State OSHMeporting ID 95o6 R El 1) El <br />26. Optional iniormation' <br />at. bupefvisor(s) Assigned <br />a. I b. <br />-- 24. -Iranuletr Date! <br />C. 0 Other Federal Agency[Code L <br />t. 0 Slatell-ocall Government <br />0 Other <br />CALOSH-90 1101991 <br />Referral ReportSTATE <br />OF CALIFORNIA <br />DEPAFJT&'r <br />OF INDUSTRIAL RELATION'S <br />DIVISION OF OCCUPAT IONAL SAFETY AND HEEALT H. <br />kri 0 D Data 11- REP0nQC' IC; iI previous A--fivluy? <br />r" 7i 3, Reisfral Number <br />V ),as, Y5- �-j No Po5nt flas this <br />I;i' EMS.' TIMB: Number: <br />Ralerral) <br />4. a b. 11stablishmem Nlam� <br />Change? % % --I— , <br />5. Empiciyar ID (State's option) <br />6. a. 0 b. Site Ad., ass (SjrqV% City, S',aj-' 71P) <br />Change? mt LlJAA <br />—Mailing <br />44 7. City Coop a. County Code <br />3. To-rass (Serest, Cly. State. ZIP) <br />Industry & <br />Ownet-ship <br />10 - pal 'of Business <br />SL <br />rimar" SIC 112' NQL of ;tmP <br />_:�� <br />13. Ow arsnip (1,)Iafk 'T" in one box) <br />5 <br />rivate Sector b, 11 Local Government C. rJ <br />State Government d. D.FCderal AgencyjCgdg I I I <br />Source <br />14. Referred By: <br />15. riate Received <br />a- 0 CSE/IH (Within office)/CSE/IH ID I <br />i. 13 Consultation <br />b. 0 Federal OSHA <br />�& <br />9. L -1 Slatail-ticall Government <br />State OSH <br />h. 11 Media <br />d. 0 Discrimination <br />i. Other (specify) <br />2. 0 Other Federal Agency/Coda <br />16. source or Contact (Name-, LocationAffiliation, -telephone Number) <br />ireierra!ty <br />Classification:. <br />17' P <br />tielmminent <br />b. Health <br />(1) Danger (2) ®SeriousOther <br />(1) 0 imminent Dancer (2) Serious(3) VOcher <br />Migrant Farmworker Camp <br />19. Hazard Description <br />% <br />V <br />0 <br />Action 20. a. ®Send Letter b- Date Letter Sent: c. Date Response <br />2. pl. <br />22. Inspection manned? <br />11 yes, <br />Yes 0 No Priority: <br />2 23 to (N <br />I Transfer to (Name): <br />25. Transfer to (Category): <br />D Federal OSHA/Reporting ID <br />L_ _j <br />b, 0 State OSHMeporting ID 95o6 R El 1) El <br />26. Optional iniormation' <br />at. bupefvisor(s) Assigned <br />a. I b. <br />-- 24. -Iranuletr Date! <br />C. 0 Other Federal Agency[Code L <br />t. 0 Slatell-ocall Government <br />0 Other <br />CALOSH-90 1101991 <br />