Department of Labor & Industries WISHA Services Division PO Box 44650 Olympia WA 98504-4650
Firm name Address Radio carrier frequency Tone coding frequencies Name of manufacturer of signal system Intended function of unit: Voice communication Area in which unit will be operated Type of tone: Sequential City
APPLICATION FOR PERMIT
TO OPERATE RADIO SIGNAL SYSTEM IN DESIGNATED AREA
Phone number State ZIP+4 Receiver's serial no.
Whistle signal
System to be used for: Control equipment Grapple Highlead, Slackline, Skidder (Area map included in Safety Standards for Logging Operations)
Balloon
1
Simultaneous If other, specify type
2
3
System purchased or acquired from Mail permit to: Address F416-087-000 app for permit 6-99 City State ZIP+4
Date system purchased or acquired:
Department Use Only Date Permit Issued / /