c. p.

0MB Approval No? 53

 

it;

US DEPARTMENT OF LABOR.
and Training Administration

to.
FURNISHED HOUSING AND FACILITIES

LonENzo GABRIEL MARQUEZ
7m STREET
nonnronon?x. 19045

I. NAME AND ADDRESS

 

2. HOUSING LOCATIONS 707 BLEVINS STREET HEREFORD. 

 

 

rx 3. HOUSING DESCRIPTION ?53 Hair) Silt cc 0

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 



 

8. COMMENTS 
NO "tater Grid}
{00 Wqu?i?U??/w

z) Luimdiow 60mng? 6Wi/Eu'.

1914205

QWWT



 

l4. SLEEP ROOMS a. Dormitory Typo b. Family Type ES USE ONLY
(No. MeasureLength i i i i 5. CAPACITY (Adults) F7
3% 8/ I 5. REGULATIONS COMPLIANCE
Width i i A proper box) Yes No
Ceiling Height 3 8 
Squnrc Feet  i i LI) Electricity 
No. of Rooms A Site 
I
No. Beds, Single a Screening 
oi?Do lb 9 i I .

Lin, of Double Birgit;

Heating 
7. FACILITIES (Number afcach)
Flush Toilets Privy Urinals Law. or 

othtubs Movable Bathtubs Laundry machines i-?rxcd laundry tubs Movable laundry
. tubs 
Smoke Detectors
Cook Stoves Rcirigcmt 5 Garbage lnincrs First -uid Kits Fire Extinguishers -
7 (NE (we) 

SEP 2 it 2015

 

9. canonization 
I CERTIFY THAT i have rcvictwd tho hou

ur






C0va

(L
6 us. Department of Lobor,( OSHA ETA. and that
the housing described horcirt( l? {docs not meet such standards. 1 hereby authorize representatives of the State Employment Services Office
nndfor Employment and Training Administration regional of?ce to inspect the above housing at any reasonable time.

 

 

 

 

 

 

 

 

 

 

Employer?s 5' nature Typed Name and Title Dane
?6 utet Mn?ouf?: Ratios 933.5

10. HOUSING INSPECTED BY:

Signature of Authorized Of?cial ?l?ypcd Name and Title brig

Sum R. arpcr. Assistant ISA 956115
ll. APPROVAL: Housing approved for occupancy by rccmitcd interstate.
Signature of Authorized Official Typed Name and Title Date
ETA 338 (Jon. l98l)