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)
[44 FR 56139, Sept. 28, 1979. Redesignated at 47 FR 57717, Dec. 28, 1982]
 
source: 44 FR 56127, Sept. 28, 1979, unless otherwise noted.