NYC 9/11 Public Portal Document
*...*Ж:*
CITY OF NEW YOF
DEP
DEPARTMENT OF ENVIRONMENTAL PROTECTIC.
BÜREAU OF NR NOLSE AND HIZNRDOUS HATELL
ASBESTOS AND LEAD CONTROL PROGRUM-TRANDG AND CERTIFICA TON UN.::
$*T7 JIMCTRON BOULEVARD, FTH FOOR CORONL NEW YOZK 117
APPLICATION FOR ASBESTOS INVESTIGATOR
AND RESTRICTED ASBESTOS INVESTIGATOR CERTIFICATION.
APPENDIX À
MEDICAL EXAMINATION FOR ASBESTOS INVESTIGATORS
APPLICANT.NAME:
HOME ADDRESS:
CITY, STATE, & ZIP:
TELEPHONE NUMBE
DATE OF BIRTH: _
SOCIAL SECURITYN
PII
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 NLAPZROPRIATE BOXI
IS NOT
*•PHYSICALLY QUALIFIED TO WEAR A RESPIRATOR IN THE
PERFORMANCE OF HIS/HER,JOR TACO2AY
PII
NYC-WTC_000120494
:
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NYC-WTC_000120494Source: NYC Law Department, mirrored locally