ML20238A061
| ML20238A061 | |
| Person / Time | |
|---|---|
| Site: | Shoreham File:Long Island Lighting Company icon.png |
| Issue date: | 04/06/1987 |
| From: | AFFILIATION NOT ASSIGNED |
| To: | |
| References | |
| OL-5-I-SC-041C, OL-5-I-SC-41C, NUDOCS 8708280295 | |
| Download: ML20238A061 (4) | |
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EXPOSURE / CONTAMINATION FORMS Form Title 1
Emergency Worker Exposure Record 2
Ei'acuee Exposure Record 3
Automobile Contamination Report Form 4
Truck Contamination Report Form 5
Bus. Contamination Report Form 6
Van Ce ntamination Report Form 7
Motorcycle Contamination Report Form l
8 Equipment / Personal Articles Contamination Report Form
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OPIP 3.9.2 FORM e2 Ew.cVEE EXPOSURE REC 0KD Page 32 of 49 1.
PE31sTRAT10N (70 SE COMPLETED Sf FACILITY PERSONNELI page 3 of 9 OATE TIME DECONTAMINATION FACILITT
- 1. NAFE (LA3fl (FSASTI in! DOLE INT.)
- 2. AGE
- 3. SEE C nALE C FEMALE A. PREONANT C TES C ho S. MONE A00RE55 6, CITT
- 7. STATE 6 !!P C00E
- 9. TELEPHONE NUMBER (HonEl
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- 10. TELEPHONE Nun!ER IBU$thES$1 (l l l J)l l l l-l l l ! l
- 11. SCCD L SECURITY NUNDER' l I I l-l i l-l i l l I II. BRIEFLY 0ESCRIBE PERSCN'S WHEREABOUTS AND ACTIVITIES.
!!!. PERSONNEL nCNf 70R!NG (70 BE ConPLETED ST F ACILITT PERSONNEL)
B ACNGROUND WITH HP-270 PROBO SHV1D CPEN com SHIELD CLOSEh com S ACKGROUND wlTA hP-210 PROSO cpm I!.k"S $-[ ENS ll COUNTS n!NUS BACMGPOUND AFTER CECCNiantNAtlom l
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- 2. C WATERLESd H AND CLE A*ER 3 CPASTE NA0E FROM MILD CETERGENT I
1ECONTAFINATIONPE}0NNEL'SINITIALS A. C LAVA SOAP Bot?Y M AP CHECK APPRCPR! ATE IMDr0 ATE AREAS OF 00NTAWINAT;0N/IMJURY FINAL ACTION:
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i OPIP 3.9.2 FORM = 3 Page 33 of 49 AUTOMOBILE CONTAMINATION REPORT FORM Page 4 of 9 LICENSE e STATE OR!vER'S NAME
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i ADDRESS (!F NON-LERDI INITIAL CXTERICR SURYEY RESULTS
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LEFT SIDE RICHT SIDE FRCNT REAR COnnENTS:
J MCNITOR'S INITIALS INSTRunENT NOCEL NO.
S/N PRCBF. TYPE INITIAL INTERIOR SURVEY RESULTS (CPM n!NUS BACMGROUN01 CCnMENTS:
nCNITCR'S INITIALS INSTRUMENT nCCEL NO.
S/N PRCOE TYPE CECON METHOD (IST. ATTEMPT):
RESULTS (CPM n!NUS BACKGROUNDS MCNITOR'S INITIALS INSTRUNENT 9CCEL NO.
S/N PRCBE TYPE DECON METHOD '2ND. A' TEMPT 1 RESULTS (CPM n!NUS SACKGROUN01:
nCNITOR'S INITIALS INSTRUNCNT MODEL NO.
S/N PaCBE TYPE DECON NETHOD L3RO. ATTEMPT):
RESULTS (CPn n!NUS BACKOROUNCI:
NONITOR'S INITIALS INSTRunENT MOCEL NO.
S/N PROSE TYPE FINAL ACTION VEHICLE DECONTAn!NATED.
CONTINUED EXTERNAL / INTERNAL CCNTAN. 360 CPM CR GREATER ABOVE BACMGRCOND.
_ INITIALS SEND COMPLETED FORn TO THE RA0!ATION HEALTH CCCROINATOR.
PAGE _ OF _
PeV. Oa 11800.C M T. 97
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