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C(TY OF NEW YORK DEPARTMENT OF ENVIRONMENTAL PROTECTION BUREAU OF AIR RESOURCES NCwYOM. N.Y. 10012 !45 LAIAYCTTC ST:tCET, • SAMUEL STEMPLER. P.E. HARVEY w. SCHULTZ As si $tons C•1um s SicAct Coauaftslonct

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APPLICANT SIGNATURE: 1 _ NCLUDED 'PULMONARY EXAMINATION WHICH 'I BASED UPON THE. MEDICAL AND FORCED EXPIRATORY CAPACITY"(FC) FUNCTION BESTS or VITAL RECENT CHEST AND AN EVALUATION OF A VOLUME AT ONE SECOND (FEVI) THAT THE ABOVE NAMED ROENTGENOGRAM IT IS MY OPINION• PATIENPHYSICALLY BOX) IS IS .HOT ("'~ (PLEASE CHECK APPROPRIATE PEILFORKANCE OF HIS/HER RESPIRATOR IN 'FW QUALIFIED To WEAR A JOB: ASBESTOS HANDLER

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ANDREW A.KAMINSKI,M.D. 08/8/00 go? PHYSICIAN ANDREW A. .yKAMt NSK1, M.D. L- 1 t&- ---- MFnlrAL - SURGICAL OFFICES GNATUtIE OF PHYSICIAN j94 NASSAU E BROOKLYN ~EWYORKu11222 /p ririi 1718)389=5775 N Y S ATE LIC.N3~O: 155454

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