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form, continue on any other sheet of paper. After you have completed the form, return it to your local OSHA office. NOTE: It is unlawful to make any false statement, representation or certification in any document filed pursuant to the Occupational Safety and Health Act of 1970. Violations can be punished by a fine of not more than $10,000. or by imprisonment of not more than six months, or by both. (Section 17(g)) Public reporting burden for this voluntary collection of information is estim.
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