Appendix A. Sample Abatement - Certification Letter (Non- mandatory)

[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]

The hazard referenced in Inspection Number [Insert 9- digit #] for violation identified as:

Citation [insert #] and item [insert #] was corrected on [insert date] by:

                                                                                          .

Citation [insert #] and item [insert #] was corrected on [insert date] by:

.

Citation [insert #] and item [insert #] was corrected on [insert date] by:

                                                                                          .

Citation [insert #] and item [insert #] was corrected on [insert date] by:

.

Citation [insert #] and item [insert #] was corrected on [insert date] by:

                                                                                          .

I attest that the information contained in this document is accurate.

Signature

Typed or Printed Name

Historical Note

Appendix A adopted effective June 26, 1998 (Supp. 98-2).