of an Elevator Inspection Report Your title Name of the organization you represent if applicable Your address Location of the elevator Inspection date What do you believe is wrong ID: 891535
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1 Petition for Reconsideration
Petition for Reconsideration of an Elevator Inspection Report __________________ Your title: _____________________________________________________________ Name of the organization you represent, if applicable: __________ ______________________________________________ Your address: _________________________________________________________ __________ Location of the elevator: _________________________________________________ Inspection date: ________________________________________________________ __________________________________________ What do you believe is wrong with the in _________________________ _________________________ _________________________ What are you asking the Labor Commissioner to do? ___________________________ _________________________ _________________________ _________________________ _________________________ Mail this form with a copy of the inspection report and all documents to be considered Elevator Safety Board Iowa Division of Labor 1000 East Grand Avenue Des Moines, Iowa 50319-0209 ________________________________ Your signature ________________________________ Date