Invoice for asbestos sample analysis, 44 Wall Street

NYC 9/11 Public Portal Document

CITY OF NEW YORK

D P DEPARTMENT OF ENVIRONM NTAL PROTECTION R MFAU OFEJVDtO%WDCALIMMMUT10NAND E ZFORCEMEC ASSES= CM%7ROLYROQUM•TRAN'IIJC AIJD CIRSi}7CATION bP17AN=0NS=jVA1m tSHF1oM=R0K&MW YORK 11364 Ui4T

AP,i'tICATION FOR ASBESTOS IIWFSTTGATOR AND RESTRICTED ASBESTOS INVESTIGATOR CERThICATION

APPENDIX A MEDICAL EXAMINATION FOR ASBESTOS INVESTiGATORS I

APPLICANT NAMED _ __

HOME ADDRESS:

CITY, STATE, & ZIP:

TELEPHONE NUMBI

DATE OF BIRTH:

SOCIAL SECURITY R

BASED UPON THE MEDICAL EXAMINATION WHICH INCLUDED PULMONARY FUNCTION TESTS OF VITAL CAPACITY (FVC) AND FORCED EXPIRATORY VOLUME AT ONE SECOND (FEV1), AND AN EVALUATION OF A RECENT CHEST ROENTGENOGRAM, IT IS MY OPINION THAT THE ABOVE NAMED PATIENT (PLEASE CHECK ('1) APPROPRIATE BOX)

IS IS NOT L~ PHYSICAL Y QUALIFIED TO WEAR A RESPIRATOR IN THE PERFORMANCE OF HIS/HER JOB.

• PRINT NAME OF PHYSICIAN DATE OF EXA INATION 66 Nassau Ave. Brooklyn, N.Y. 11I~t2 SIGNATU$JOF PHYSICIAN ADDRESS (718) 383-4600 STATE LICENSE NUMBER TELEPHONE NUMBER

NYC-WTC 000094983