Ariz. Admin. Code § tit. 20, ch. 05, art. 6, app B
(Name), Director
The Industrial Commission of Arizona
Division of Occupational Safety and Health
P. O. Box 19070
Phoenix, Arizona 85005
[Company's Name]
[Company's Address]
Check one:
Abatement Plan [ ]
Progress Report [ ]
Inspection Number ______________________
Page ________of__________
Citation Number(s)*______________________
Item Number(s)* ________________________
Proposed
Completion Completion
Action Date (for Date (for
abatement progress reports
plans only) only)
.................. ....
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Date required for final abatement:___________________
I attest that the information contained in this document
is accurate.
______________________________________________
Signature
______________________________________________
Typed or Printed Name
Name of primary point of contact for questions: (optional)
Telephone number: ______________________________
*Abatement plans or progress reports for more than one citation item may be combined in a single abatement plan or progress report if the abatement actions, proposed completion dates, and actual completion dates (for progress reports only) are the same for each of the citation items.
Ariz. Admin. Code tit. 20, ch. 05, art. 6, app B