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Attachment F: <br />I{t-Herslrlr <br />.tn tftirE"l T{ithdnn'a.l Fotm <br />U.rt€ sf ltrqu!9t: <br />F*rm in.rtrsfit-}for: <br />1. OSH Emrrgrncy Frrgrrcdnrs: rnd Ra:p+n:r {EPfi.l irrv:q-lrt,p ts, rralir.E r.rqu€it! f*rlntivirtl <br />.rud ir|tbfl : f r'=rn hcrl h cllth ju ri: dl-t'*:'nr. <br />?, T.=*rdcrrntivirab. rrequcrtingLilJ:imptynrrdrt:ror'mp.htrttfuf.:'rrn.Onrc.:a'mphtc:crnth:fnrrn <br />rnd:rnril itte irs.:he.hr::rttFdsh.'rvr*sr, rnd tr€'urtr!'t',f,':.Fl d*hlaclgEd+h.r*a"=u,'r' u.rin6 .Antiuirel <br />'tlj'rthdrewrl" in thc rubpct liac. <br />3. qSH Emcrgrncg Prtprrrincs: rnd Resp:*ast ,lEFRl '.,uill s!€,rdir.rtc re qu*:t'rrrith th! +t'elfiintlifl ltrfi: <br />Fhrrm*y fur+:irt'r,*n te t!rif!,iuFFlF chein *:tir'ity. Then,,:,n,:a th,! rEqa.Ert h* br'rn:ppr,+*rd by <br />0*H lcrder:hip, BOtl EPR rtrff will $lo.rk tE h€rbE the regu'r:tcd medkrti:'n: in ritft:rth: rurrcnt <br />supp.lychein ,rr rto{ftfr'rm thc DSt{ crch,r. <br />4. Fn!di.rti+n::rcerreibbk,$StltPR:t*fvrill osntr:tth'!r'rEuqrtir6k€:l h,r.:lth jurtrdktio,nt+ <br />a*nfirm:hipping l:ceti:n :nd F+int sfosnErt. <br />5. DSt! EF R will *sin r cust:nr r end ,:'ndr r n u rntc r t'l tie ruq ue :{ing h.crl hc.rhlr ju ri:d hti*n. rnnotrt! <br />tftc n u mbe r sn FiSE twe. end :rrn"ft mril ,*ut ttc ep,pn:r+l'd q u:rnthp' ':'{ tntirir:b te thr rrq uc:ting lccal <br />ht.rhft ju ri:dkti:n. Eltinrtcd tirnr ':,1 lrrivrl dr g.r nds u pa'n tlrr u 16r nq. o'f tic :itu.eti*n. tirnc rcccivld. <br />:nd gcc6r:rphic hcrti:n. <br />€. Tht r,rquc:tin5 lx:l hcrhft jrrfudktbn rrill .ti5n.rnd 'd:tc t, xknE.,rhdg*: nealiptxf rnlirirek up:,n <br />dc li*r ry. <br />?. Tht r:quc:ting |o<rl hcrlth juti:dicti,=n rdll qgr.rc t:,retnrc & islual u,ffIlll5Ff, rrr{Ur&r 6Oo!sw.rvith <br />an erpir$bn drt t.f ut lEilt ther yctrs {'ut s:ir5thr $ntir'irrl f;i{turrr fr:'rrn ,lfqs 31, <br />E. OSH tPR will retain thE rsriFl€ttd rlntisirel Vfhhdrsrqil F:.rrn fr*r'3'perrs. <br />Fc,rytrthg lod hcalth iubdaicrr: <br />{bgmi!.tio{r ftrt dr{ lord h.rldr iubdctio*ir nrryr:*ergtl* mra$rgrfuo*for: <br />,i-+ntr3t:Tnk <br />lrisnE g:E-hl ril: <br />R€qurjtcd Anti\.irab {includc type. :irr ed qurnti\,1 <br />iEr: Ia.rnifu, 75m9, JEpo4s af tOp.;IJrl <br />3nrFFilr€ St{l n!l': <br />57