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CGA-3

Policy Exhibit #3 CGA

Chemical and Hazardous Materials Information

Brand Name or Common Name:

______________________________________________________________________________

If MSDS follows, check here: _____

______________________________________________________________________________

Manufacturer and/or Distributor:

______________________________________________________________________________

Typical or Intended Use:

______________________________________________________________________________

Chemical Ingredients:

______________________________________________________________________________

First Aid:

______________________________________________________________________________

Other Information:

______________________________________________________________________________

Date:                                                    

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