NYC 9/11 Public Portal Document
ANDO INTERNATIONAL INC.
Suite 14, Brooklyn, NY 11222
861 Manhattan Ave.,
« Tel. (718) 349-6212
QUALITATIVE RESPIRATOR FIT TEST
(twelve) months from the date of test
This Respirator Fit Test is valid for the period of 12
Date of birth:;
NameH
SSN•
Addresi P I I 1.
Telephone•
r -----------------------
Test Agent:
Test Provider: ANDO INTERNATIONAL INC.
1. Irritant Smoke I
Address: 861 Manhattan Ave., Brooklyn, NY 11222
2. Odorous Vapor
Telephone: (718) 349-6212
3. Taste Test
Fax: (718) 349-3238
RESPIRATORS TESTED - SUCCESSFUL TEST
(Half Face Mask only)
SIZE: (t) (2) ~+
BRAND NAME: (i) v (2) -----
TEST DATE: 0 1S lof
Name of person performing respirator fit test:
l"l,f?5?1 t'/',, 7,' W
Qof a 0 1--0( Signature:
Fit test number:
t
NYC-WTC 000094981
OCR can misread numbers and units. Confirm readings against the page image before using them.