In May 2001, NIOSH received a confidential employee request for a Health Hazard Evaluation at Dixie Cultured Marble (DCM) in Birmingham, Alabama. Employees were concerned with exposures to PVC glue, fiberglass, acetone, organic peroxide, and unsaturated polyester resins in the production of cultured marble vanities, bathtubs, and shower walls and floors. Employees reported symptoms that included itchy skin, breathing problems, and headaches. In response to employee concerns, NIOSH investigators conducted an initial site visit on December 9-10, 2004, and a follow-up site visit on June 21-22, 2005. During the initial site visit, NIOSH investigators collected general area (GA) and personal breathing zone (PBZ) air samples for volatile organic compounds, collected tape samples from consenting employees' arms and a bulk sample of cultured marble dust to be analyzed for fiberglass and identified areas within the facility where they perceived elevated noise levels. They also interviewed DCM employees to gather information on demographics, health problems (work-related and non-work related), work practices, and workplace personal hygiene. During the follow-up site visit, PBZ air samples were collected for total and respirable particulate, styrene, alpha-methyl styrene, and methyl methacrylate. Noise dosimeters were placed on selected workers. Respirable particulate, alpha-methyl styrene, and methyl methacrylate air sample concentrations were all below relevant evaluation criteria. The product grinder's total particulate exposure exceeded the Occupational Safety and Health Administration (OSHA) and American Conference of Governmental Industrial Hygienists (ACGIH), 8-hr time-weighted average (TWA) exposure limits. Styrene concentrations for two employees casting cultured marble exceeded the ACGIH 8-hr TWA of 20 parts per million (ppm). Noise monitoring data indicated that the daily noise doses of the product grinder and a product buffer exceeded the OSHA permissible exposure limit, and 10 of 11 evaluated employees exceeded the NIOSH-recommended daily allowable noise dose. Twelve of 15 employees were interviewed. Four of 12 employees reported respiratory problems and skin irritation. Based on personal air sampling, noise monitoring, and employee interviews, NIOSH investigators conclude that a health hazard exists from exposure to total particulate, styrene, and noise. Recommendations to minimize exposures include improving existing ventilation systems, creating respiratory and hearing loss prevention programs, using improved hearing protection devices, and ensuring consistent use of respiratory protection.