+---------------+----+----------+---+------------+---+------------------+---+
| **SAFETY,     |    |          |   | **Date:**  | * |                  |   |
| HEALTH AND    |    |          |   | October    | * |                  |   |
| ENVIRONMENTAL |    |          |   | 2003       | L |                  |   |
| MANAGEMENT    |    |          |   |            | o |                  |   |
| COMMITTEE**   |    |          |   |            | c |                  |   |
|               |    |          |   |            | a |                  |   |
| **IN          |    |          |   |            | t |                  |   |
| STRUCTIONS:** |    |          |   |            | i |                  |   |
|               |    |          |   |            | o |                  |   |
| 1\. Post a    |    |          |   |            | n |                  |   |
| copy in a     |    |          |   |            | N |                  |   |
| prominent     |    |          |   |            | a |                  |   |
| place for     |    |          |   |            | m |                  |   |
| employees'    |    |          |   |            | e |                  |   |
| information   |    |          |   |            | a |                  |   |
| by October 15 |    |          |   |            | n |                  |   |
| each year.    |    |          |   |            | d |                  |   |
|               |    |          |   |            | A |                  |   |
| 2\. Send a    |    |          |   |            | d |                  |   |
| copy to the   |    |          |   |            | d |                  |   |
| MWA SHEM      |    |          |   |            | r |                  |   |
| Office, 1815  |    |          |   |            | e |                  |   |
| N.            |    |          |   |            | s |                  |   |
| University,   |    |          |   |            | s |                  |   |
| Peoria,       |    |          |   |            | : |                  |   |
| Illinois      |    |          |   |            | * |                  |   |
| 61604-3999.   |    |          |   |            | * |                  |   |
|               |    |          |   |            |   |                  |   |
| 3\. Send a    |    |          |   |            | * |                  |   |
| copy to       |    |          |   |            | * |                  |   |
| SHEMB, 5601   |    |          |   |            | U |                  |   |
| Sunnyside     |    |          |   |            | S |                  |   |
| Avenue, MS    |    |          |   |            | D |                  |   |
| 5127          |    |          |   |            | A |                  |   |
| Beltsville,   |    |          |   |            | , |                  |   |
| MD            |    |          |   |            | R |                  |   |
| 20705-5127.   |    |          |   |            | E |                  |   |
|               |    |          |   |            | E |                  |   |
| 4\. Provide   |    |          |   |            | , |                  |   |
| updated       |    |          |   |            | A |                  |   |
| copies as     |    |          |   |            | R |                  |   |
| changes in    |    |          |   |            | S |                  |   |
| appointments  |    |          |   |            | , |                  |   |
| or membership |    |          |   |            | M |                  |   |
| occur.        |    |          |   |            | W |                  |   |
|               |    |          |   |            | A |                  |   |
|               |    |          |   |            | * |                  |   |
|               |    |          |   |            | * |                  |   |
|               |    |          |   |            |   |                  |   |
|               |    |          |   |            | S |                  |   |
|               |    |          |   |            | o |                  |   |
|               |    |          |   |            | i |                  |   |
|               |    |          |   |            | l |                  |   |
|               |    |          |   |            | s |                  |   |
|               |    |          |   |            | M |                  |   |
|               |    |          |   |            | a |                  |   |
|               |    |          |   |            | n |                  |   |
|               |    |          |   |            | a |                  |   |
|               |    |          |   |            | g |                  |   |
|               |    |          |   |            | e |                  |   |
|               |    |          |   |            | m |                  |   |
|               |    |          |   |            | e |                  |   |
|               |    |          |   |            | n |                  |   |
|               |    |          |   |            | t |                  |   |
|               |    |          |   |            | R |                  |   |
|               |    |          |   |            | e |                  |   |
|               |    |          |   |            | s |                  |   |
|               |    |          |   |            | e |                  |   |
|               |    |          |   |            | a |                  |   |
|               |    |          |   |            | r |                  |   |
|               |    |          |   |            | c |                  |   |
|               |    |          |   |            | h |                  |   |
|               |    |          |   |            |   |                  |   |
|               |    |          |   |            | 8 |                  |   |
|               |    |          |   |            | 0 |                  |   |
|               |    |          |   |            | 3 |                  |   |
|               |    |          |   |            | I |                  |   |
|               |    |          |   |            | o |                  |   |
|               |    |          |   |            | w |                  |   |
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|               |    |          |   |            | u |                  |   |
|               |    |          |   |            | e |                  |   |
|               |    |          |   |            |   |                  |   |
|               |    |          |   |            | M |                  |   |
|               |    |          |   |            | o |                  |   |
|               |    |          |   |            | r |                  |   |
|               |    |          |   |            | r |                  |   |
|               |    |          |   |            | i |                  |   |
|               |    |          |   |            | s |                  |   |
|               |    |          |   |            | , |                  |   |
|               |    |          |   |            | M |                  |   |
|               |    |          |   |            | i |                  |   |
|               |    |          |   |            | n |                  |   |
|               |    |          |   |            | n |                  |   |
|               |    |          |   |            | e |                  |   |
|               |    |          |   |            | s |                  |   |
|               |    |          |   |            | o |                  |   |
|               |    |          |   |            | t |                  |   |
|               |    |          |   |            | a |                  |   |
|               |    |          |   |            | 5 |                  |   |
|               |    |          |   |            | 6 |                  |   |
|               |    |          |   |            | 2 |                  |   |
|               |    |          |   |            | 6 |                  |   |
|               |    |          |   |            | 7 |                  |   |
+---------------+----+----------+---+------------+---+------------------+---+
|               |    |          |   | **Number   |   |                  |   |
|               |    |          |   | of         |   |                  |   |
|               |    |          |   | p          |   |                  |   |
|               |    |          |   | ermanent** |   |                  |   |
|               |    |          |   |            |   |                  |   |
|               |    |          |   | *          |   |                  |   |
|               |    |          |   | *full-time |   |                  |   |
|               |    |          |   | employees  |   |                  |   |
|               |    |          |   | at         |   |                  |   |
|               |    |          |   | l          |   |                  |   |
|               |    |          |   | ocation:** |   |                  |   |
|               |    |          |   | 29         |   |                  |   |
+---------------+----+----------+---+------------+---+------------------+---+
|               |    |          |   | **Field    |   |                  |   |
|               |    |          |   | Federal    |   |                  |   |
|               |    |          |   | Safety &   |   |                  |   |
|               |    |          |   | Health     |   |                  |   |
|               |    |          |   | Council    |   |                  |   |
|               |    |          |   | mem        |   |                  |   |
|               |    |          |   | bership?** |   |                  |   |
|               |    |          |   | Yes        |   |                  |   |
+---------------+----+----------+---+------------+---+------------------+---+
| **COMMITTEE   |    |          |   |            |   |                  |   |
| MEMBERS /     |    |          |   |            |   |                  |   |
| REPR          |    |          |   |            |   |                  |   |
| ESENTATIVES** |    |          |   |            |   |                  |   |
+---------------+----+----------+---+------------+---+------------------+---+
| **Name**      | ** | *        | * |            |   | **Office         |   |
|               | Un | *Phone** | * |            |   | Address**        |   |
|               | it |          | J |            |   |                  |   |
|               | ** |          | o |            |   |                  |   |
|               |    |          | b |            |   |                  |   |
|               |    |          | S |            |   |                  |   |
|               |    |          | e |            |   |                  |   |
|               |    |          | r |            |   |                  |   |
|               |    |          | i |            |   |                  |   |
|               |    |          | e |            |   |                  |   |
|               |    |          | s |            |   |                  |   |
|               |    |          | a |            |   |                  |   |
|               |    |          | n |            |   |                  |   |
|               |    |          | d |            |   |                  |   |
|               |    |          | T |            |   |                  |   |
|               |    |          | i |            |   |                  |   |
|               |    |          | t |            |   |                  |   |
|               |    |          | l |            |   |                  |   |
|               |    |          | e |            |   |                  |   |
|               |    |          | * |            |   |                  |   |
|               |    |          | * |            |   |                  |   |
+---------------+----+----------+---+------------+---+------------------+---+
| Steve         | S  | 320-     | G |            |   | 803 Iowa Avenue  |   |
| VanKempen     | oi | 589-3411 | S |            |   |                  |   |
| **Chair**     | ls | x108     | - |            |   |                  |   |
|               |    |          | 0 |            |   |                  |   |
|               |    |          | 4 |            |   |                  |   |
|               |    |          | 0 |            |   |                  |   |
|               |    |          | 4 |            |   |                  |   |
|               |    |          |   |            |   |                  |   |
|               |    |          | A |            |   |                  |   |
|               |    |          | g |            |   |                  |   |
|               |    |          | r |            |   |                  |   |
|               |    |          | i |            |   |                  |   |
|               |    |          | c |            |   |                  |   |
|               |    |          | u |            |   |                  |   |
|               |    |          | l |            |   |                  |   |
|               |    |          | t |            |   |                  |   |
|               |    |          | u |            |   |                  |   |
|               |    |          | r |            |   |                  |   |
|               |    |          | a |            |   |                  |   |
|               |    |          | l |            |   |                  |   |
|               |    |          | S |            |   |                  |   |
|               |    |          | c |            |   |                  |   |
|               |    |          | i |            |   |                  |   |
|               |    |          | R |            |   |                  |   |
|               |    |          | e |            |   |                  |   |
|               |    |          | s |            |   |                  |   |
|               |    |          | T |            |   |                  |   |
|               |    |          | e |            |   |                  |   |
|               |    |          | c |            |   |                  |   |
|               |    |          | h |            |   |                  |   |
|               |    |          | n |            |   |                  |   |
|               |    |          | c |            |   |                  |   |
|               |    |          | n |            |   |                  |   |
+---------------+----+----------+---+------------+---+------------------+---+
| Chuck Hennen  | S  | 320-     | G |            |   | 803 Iowa Avenue  |   |
| **Member**    | oi | 589-3411 | S |            |   |                  |   |
|               | ls | x102     | - |            |   |                  |   |
|               |    |          | 0 |            |   |                  |   |
|               |    |          | 4 |            |   |                  |   |
|               |    |          | 0 |            |   |                  |   |
|               |    |          | 4 |            |   |                  |   |
|               |    |          |   |            |   |                  |   |
|               |    |          | A |            |   |                  |   |
|               |    |          | g |            |   |                  |   |
|               |    |          | r |            |   |                  |   |
|               |    |          | i |            |   |                  |   |
|               |    |          | c |            |   |                  |   |
|               |    |          | u |            |   |                  |   |
|               |    |          | l |            |   |                  |   |
|               |    |          | t |            |   |                  |   |
|               |    |          | u |            |   |                  |   |
|               |    |          | r |            |   |                  |   |
|               |    |          | a |            |   |                  |   |
|               |    |          | l |            |   |                  |   |
|               |    |          | S |            |   |                  |   |
|               |    |          | c |            |   |                  |   |
|               |    |          | i |            |   |                  |   |
|               |    |          | R |            |   |                  |   |
|               |    |          | e |            |   |                  |   |
|               |    |          | s |            |   |                  |   |
|               |    |          | T |            |   |                  |   |
|               |    |          | e |            |   |                  |   |
|               |    |          | c |            |   |                  |   |
|               |    |          | h |            |   |                  |   |
|               |    |          | n |            |   |                  |   |
|               |    |          | c |            |   |                  |   |
|               |    |          | n |            |   |                  |   |
+---------------+----+----------+---+------------+---+------------------+---+
| Beth          | S  | 320-     | G |            |   | 803 Iowa Avenue  |   |
| Burmeister    | oi | 589-3411 | S |            |   |                  |   |
| **Member**    | ls | x111     | - |            |   |                  |   |
|               |    |          | 0 |            |   |                  |   |
|               |    |          | 3 |            |   |                  |   |
|               |    |          | 2 |            |   |                  |   |
|               |    |          | 6 |            |   |                  |   |
|               |    |          |   |            |   |                  |   |
|               |    |          | O |            |   |                  |   |
|               |    |          | f |            |   |                  |   |
|               |    |          | f |            |   |                  |   |
|               |    |          | A |            |   |                  |   |
|               |    |          | u |            |   |                  |   |
|               |    |          | t |            |   |                  |   |
|               |    |          | o |            |   |                  |   |
|               |    |          | m |            |   |                  |   |
|               |    |          | a |            |   |                  |   |
|               |    |          | t |            |   |                  |   |
|               |    |          | i |            |   |                  |   |
|               |    |          | o |            |   |                  |   |
|               |    |          | n |            |   |                  |   |
|               |    |          | A |            |   |                  |   |
|               |    |          | s |            |   |                  |   |
|               |    |          | s |            |   |                  |   |
|               |    |          | i |            |   |                  |   |
|               |    |          | s |            |   |                  |   |
|               |    |          | t |            |   |                  |   |
|               |    |          | a |            |   |                  |   |
|               |    |          | n |            |   |                  |   |
|               |    |          | t |            |   |                  |   |
+---------------+----+----------+---+------------+---+------------------+---+
| Jim Eklund    | S  | 320-     | G |            |   | 803 Iowa Avenue  |   |
| **Member**    | oi | 589-3411 | S |            |   |                  |   |
|               | ls | x149     | - |            |   |                  |   |
|               |    |          | 0 |            |   |                  |   |
|               |    |          | 3 |            |   |                  |   |
|               |    |          | 3 |            |   |                  |   |
|               |    |          | 5 |            |   |                  |   |
|               |    |          |   |            |   |                  |   |
|               |    |          | C |            |   |                  |   |
|               |    |          | o |            |   |                  |   |
|               |    |          | m |            |   |                  |   |
|               |    |          | p |            |   |                  |   |
|               |    |          | u |            |   |                  |   |
|               |    |          | t |            |   |                  |   |
|               |    |          | e |            |   |                  |   |
|               |    |          | r |            |   |                  |   |
|               |    |          | A |            |   |                  |   |
|               |    |          | s |            |   |                  |   |
|               |    |          | s |            |   |                  |   |
|               |    |          | i |            |   |                  |   |
|               |    |          | s |            |   |                  |   |
|               |    |          | t |            |   |                  |   |
|               |    |          | a |            |   |                  |   |
|               |    |          | n |            |   |                  |   |
|               |    |          | t |            |   |                  |   |
+---------------+----+----------+---+------------+---+------------------+---+
| Jay Hanson    | S  | 320-     | G |            |   | 803 Iowa Avenue  |   |
| **Member**    | oi | 589-3411 | S |            |   |                  |   |
|               | ls | x130     | - |            |   |                  |   |
|               |    |          | 1 |            |   |                  |   |
|               |    |          | 3 |            |   |                  |   |
|               |    |          | 1 |            |   |                  |   |
|               |    |          | 1 |            |   |                  |   |
|               |    |          |   |            |   |                  |   |
|               |    |          | P |            |   |                  |   |
|               |    |          | h |            |   |                  |   |
|               |    |          | y |            |   |                  |   |
|               |    |          | s |            |   |                  |   |
|               |    |          | i |            |   |                  |   |
|               |    |          | c |            |   |                  |   |
|               |    |          | a |            |   |                  |   |
|               |    |          | l |            |   |                  |   |
|               |    |          | S |            |   |                  |   |
|               |    |          | c |            |   |                  |   |
|               |    |          | i |            |   |                  |   |
|               |    |          | e |            |   |                  |   |
|               |    |          | n |            |   |                  |   |
|               |    |          | c |            |   |                  |   |
|               |    |          | e |            |   |                  |   |
|               |    |          | T |            |   |                  |   |
|               |    |          | e |            |   |                  |   |
|               |    |          | c |            |   |                  |   |
|               |    |          | h |            |   |                  |   |
|               |    |          | n |            |   |                  |   |
|               |    |          | c |            |   |                  |   |
|               |    |          | n |            |   |                  |   |
+---------------+----+----------+---+------------+---+------------------+---+
| Dr. Abdullah  | S  | 320-     | G |            |   | 803 Iowa Avenue  |   |
| Jaradat       | oi | 589-3411 | S |            |   |                  |   |
| **Member**    | ls | x182     | - |            |   |                  |   |
|               |    |          | 0 |            |   |                  |   |
|               |    |          | 4 |            |   |                  |   |
|               |    |          | 7 |            |   |                  |   |
|               |    |          | 1 |            |   |                  |   |
|               |    |          |   |            |   |                  |   |
|               |    |          | S |            |   |                  |   |
|               |    |          | u |            |   |                  |   |
|               |    |          | p |            |   |                  |   |
|               |    |          | e |            |   |                  |   |
|               |    |          | r |            |   |                  |   |
|               |    |          | v |            |   |                  |   |
|               |    |          | i |            |   |                  |   |
|               |    |          | s |            |   |                  |   |
|               |    |          | o |            |   |                  |   |
|               |    |          | r |            |   |                  |   |
|               |    |          | y |            |   |                  |   |
|               |    |          | R |            |   |                  |   |
|               |    |          | e |            |   |                  |   |
|               |    |          | s |            |   |                  |   |
|               |    |          | A |            |   |                  |   |
|               |    |          | g |            |   |                  |   |
|               |    |          | r |            |   |                  |   |
|               |    |          | o |            |   |                  |   |
|               |    |          | n |            |   |                  |   |
|               |    |          | o |            |   |                  |   |
|               |    |          | m |            |   |                  |   |
|               |    |          | i |            |   |                  |   |
|               |    |          | s |            |   |                  |   |
|               |    |          | t |            |   |                  |   |
+---------------+----+----------+---+------------+---+------------------+---+
| Pam Groth     | S  | 651-     | G |            |   | 1561 Lindig      |   |
| **Member**    | oi | 649-5046 | S |            |   | Street, St.      |   |
|               | ls |          | - |            |   | Paul, MN         |   |
|               |    |          | 0 |            |   |                  |   |
|               |    |          | 3 |            |   |                  |   |
|               |    |          | 4 |            |   |                  |   |
|               |    |          | 1 |            |   |                  |   |
|               |    |          |   |            |   |                  |   |
|               |    |          | A |            |   |                  |   |
|               |    |          | d |            |   |                  |   |
|               |    |          | m |            |   |                  |   |
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|               |    |          | i |            |   |                  |   |
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|               |    |          | e |            |   |                  |   |
|               |    |          | O |            |   |                  |   |
|               |    |          | f |            |   |                  |   |
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|               |    |          | i |            |   |                  |   |
|               |    |          | c |            |   |                  |   |
|               |    |          | e |            |   |                  |   |
|               |    |          | r |            |   |                  |   |
+---------------+----+----------+---+------------+---+------------------+---+
| **SUBMITTING  |    | **C      |   |            |   | **COOPERATOR OR  |   |
| OFFICIAL:**   |    | ONTACT** |   |            |   | UNIVERSITY       |   |
|               |    | (Name    |   |            |   | SAFETY OFFICE    |   |
| (Name, title, |    | and      |   |            |   | SERVICING        |   |
| and mailing   |    | title)   |   |            |   | LOCATION**       |   |
| address)      |    |          |   |            |   |                  |   |
|               |    | Pam      |   |            |   | (Name, title,    |   |
| Pam Groth,    |    | Groth,   |   |            |   | mailing address, |   |
| A             |    | Admini   |   |            |   | and phone        |   |
| dministrative |    | strative |   |            |   | number)          |   |
| Officer       |    | Officer  |   |            |   |                  |   |
|               |    |          |   |            |   | \~ NA \~         |   |
| USDA-ARS      |    | \- -     |   |            |   |                  |   |
|               |    |  - - - - |   |            |   |                  |   |
| 1561 Lindig   |    |  - - - - |   |            |   |                  |   |
| Street        |    |  - - - - |   |            |   |                  |   |
|               |    |  - - - - |   |            |   |                  |   |
| St. Paul,     |    |  - - - - |   |            |   |                  |   |
| Minnesota     |    |  - - - - |   |            |   |                  |   |
| 55108         |    |  - - - - |   |            |   |                  |   |
|               |    | -        |   |            |   |                  |   |
|               |    |          |   |            |   |                  |   |
|               |    | Phone \# |   |            |   |                  |   |
|               |    | 651-     |   |            |   |                  |   |
|               |    | 649-5046 |   |            |   |                  |   |
|               |    |          |   |            |   |                  |   |
|               |    | Fax \#   |   |            |   |                  |   |
|               |    | 651-     |   |            |   |                  |   |
|               |    | 649-5055 |   |            |   |                  |   |
+---------------+----+----------+---+------------+---+------------------+---+

Form ARS-309 (Aug 81) Revised MWA (Sept 02)