NYC 9/11 Public Portal Document
Sp Tis Ca oF New York Denna oF ENvi2ONMENTAL PROTECTION ~
mas JOEL A. MIELE, Shy PE. Commissioner. ROBERT C. AVALTRONI
Deputy Commissioner
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. - Als, Noise, & Hazardous
Materials
APPLICATION FOR ASBESTOS INVESTIGATOR aa
LAND RESTRICTED ASBESTOS INVESTIGATOR CERTIFICATION
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APPLICANT NAME: _ BAL PLY TADEUSZ.
HOME ADDRESS: 1
CITY, STATE, & ZIP: _
TELEPHONE NUMBEF
DATE OF BIRTH: ___
SOCIAL SECURITY Nt
APPLICANT’ S SIGNATURE -
4 YE blots ~ I
BASED UPON ‘THE MEDICAL EXAMINATION WHICH INCLUDED __
PULMONARY - FUNCTION TESTS OF VITAL CAPACITY (FVC)
AND FORCED EXPIRATORY VOLUME AT ONE SECOND
(FEV,), AND ANEVALUATION OF A RECENT CHEST
NAMED PATENT PLEASE Cree are ABOVE
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. oF : is. “S - ‘a ISNOT
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PHYSICALLY QUALIFIED TO WEAR A RESPIRATOR IN THE
PERFORMANCE OF HIS/HER JOB. .
HEIGHT: Pil
ToRacco! ie << _SetzoreszeriversY: \\Q acrornosza: NO!
X-RAY CHEST: NSA “PRR: Yos —
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MARK I. KAMINSKI M-D/
PRINT NAME QF N DATE OF INATION
MARK |. KAMINSKI, M.D.
TERNAL MEDICINE
127 BEDFORD AVE. BROOKLYN, NY Tat
STATE LICENSE NUMBER a: “TELERHONE UME
NYC-WTC_000094980
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NYC-WTC_000094980Source: NYC Law Department, mirrored locally