ANDO INTERNATIONAL
410 • Jackson
INC. 1372
Heights, New York 1
74-09 37th Av Suite
713-779-0522
FIT TEST
QUALITATIVE RESPIRATOR
months from the date of test
of 12 &twelve)
Test is valid for the period
This Respirator Fit
Nar
Adi
ADO INTERNAT1 AL INC. 1. Irritant Smoke ~~
Test provider:
Address: 861 Manhattan Ave., Brooklyn, NY 11222 2. Odorous Vapor___- •
Telephone: (718) 349-6212 3. Taste Test ---
Fax: (718) 349-3238
SUCCESSFUL TEST
RESPIRATORS TESTED -
(Half Face Mask only)
N U i 1 (2) ' __- SIZE: (t)MC—.
BRAND NAME: (►)__—
---------------------------------------------------------------------------------------
PEST DATE: 1 1~ O
Name of person performing
Fit test number: S ~` '
respirator fit tcst:_
Signature:___:
i , II
NYC-WTC 000120496
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000120496Source: NYC Law Department, mirrored locally