Code of Federal Regulations Title 40. Protection of Environment 40 CFR Pt. 211, App. A—COMPLIANCE AUDIT TESTING REPORT

Data Sheet

Company name:  __________________

Address:  ______________________

Test laboratory:  __________________

Address:  ______________________

Model number of hearing protector:  _____

Category designation:  ______________

Production date:  __________________

Test Results—Frequency, Mean Attenuation, and Standard Deviation

125 __________________________

250 __________________________

500 __________________________

1000 _________________________

2000 _________________________

3150 _________________________

4000 _________________________

6300 _________________________

8000 _________________________

Noise Reduction Rating:  ____________

If replacement hearing protector was necessary to conduct test, reason for replacement:

This report is submitted under sections 8 and 13 of the Noise Control Act of 1972. All testing, for which data are reported here, was conducted in strict conformance with applicable regulations under 40 CFR Part 211, et seq. All the data reported here are true and accurate representations of this testing. All other information reported here is, to the best of (company name) and (test laboratory name) knowledge, true and accurate. I am aware of the penalties associated with violation of the Noise Control Act of 1972 and the regulations published under it.

____________________________

(Authorized representative of company)

____________________________

(Authorized representative of test laboratory)