(Form 1010A is required to be filled out by Carrier/Self Insured Employer and Health Care Provider) The requested Treatment or Testing is delayed due to a Suspension of Prior Authorization Due to Lack of Information

FIRST REQUEST (Form 101 OA is required to be filled out by Carrier/Self Insured Employer and Health Care Provider) The requested Treatment or Testing is delayed because minimum information required by rule was not provided .

Download the VETS Form 1010a for instructions on completing and submitting the Form 1010. Next, submit your FORM 1010 by mail, email, or fax to: Veterans’ Employment and Training Service (VETS)

LWC FORM 1010A - FIRST REQUEST PLEASE PRINT OR TYPE SECTION 1. IDENTIFYING INFORMATION Last Name: First: Middle: Social Security Number: Employers Name: Claim Number (if known): P A T I E N T SECTION 2. CARRIER/SELF INSURED EMPLOYER'S FIRST REQUEST FOR REQUIRED MINIMUM INFORMATION

FORM 1010A: ENVIRONMENTAL DISCLOSURE Applicant Name(s): Property Owner Name (If different than Applicant): Please answer all questions. All questions below pertain to the property you propose to pledge. 1. Are you aware of any past uses of the property that may have created hazardous waste contamination of the property or its groundwater?

1010A DEADLOCK STANDARD FEATURES: • Mechanical deadlock • Six heavy-duty tumblers • Mounting fasteners OPTIONAL FEATURES: EXTENDED BOLT - Used for stop side mounting. Specify “1-1/4”.” HOLLOW METAL MOUNTING - Used for hollow metal door application. Specify “HM.(See page G17) GRATING DOOR MOUNTING - Used for grating door application.

The TPI 1010a Indoor Air Quality (IAQ) Meter is a state of the art, easy to use tester designed to provide you with the necessary measurements to monitor and make adjustments to air handling devices. The 1010a IAQ meter uses state of the art sensors to measure carbon dioxide (CO2), and temperature.

These standards are two of three required method options for determination of the ignitability characteristic in liquid wastes, see 40 CFR 261.21(a)(1). Currently, these ASTM standards can be obtained from Global Engineering Documents, 15 Iverness Way East, Englewood, CO 80112, 1-800-854-7179, http://global.ihs.com.

Model 1010A is a particulate respirator designed to protect the wearer from breathing particulates, etc., regardless of the presence of oil mist etc. Do NOT use Model 1010A in the environment described as “ DANGER” and “ WARNING” below. Model 1010A DANGER indicates an imminently hazardous situation. Unless following the

マスクは、鼻や口部分を衛生または防護目的で覆い粒子物質を体内に入らないようにさせる呼吸用保護具です。 ミドリ安全はサージカルマスクや有害ガス・粉じんミスト発生・酸欠環境などの作業現場に適した防じんマスク・防毒マスク・送気マスク・空気呼吸器、簡易衛生マスク、電動ファン付呼吸用保護具など多種マスク類を用意しております。 防じんマスクとは？ 防じんマスク（防塵マスク）とは、粉じんやミストが発生する溶接作業や研磨作業や解体作業などの現 …