NYC 9/11 Public Portal Document
= 2 Pil
CITY OF NEW YORK
Py DEPARTMENT OF ENVIRONMENTAL PROTECTION
| BUREAU OF ENVIRONMENTAL REMEDIATION AND ENFORCEMENT
ASBESTOS CONTROL PROGRAM - TRAINING AND CERTIFICATION UNIT
Rag 50-17 JUNCTION BOULEVARD, 8TH FLOOR, CORONA, NEW YORK 11068
APPLICATION FOR ASBESTOS INVESTIGATOR
AND RESTRICTED ASBESTOS INVESTIGATOR CERTIFICATION
APPENDIX A
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APPLICANT NAME
HOME ADDRESS:
CITY, STATE, & ZIP eo
' ZEN ' I] |
TELEPHONE NUME 1. bial
DATE OF BIRTH: _| MAR = 2. 200
SOCIAL SECURITY ppieereecem
: poe oe
oy
BASED UPON THE MEDICAL EXAMINATION WHICH INCLUDED
PULMONARY FUNCTION TESTS OF VITAL CAPACITY (FVC)
AND FORCED EXPIRATORY VOLUME AT ONE SECOND
(FEV;), AND AN EVALUATION OF A RECENT CHEST
: ROENTGENOGRAM_T tS My OPINION THAT THE ABOVI:
’ NAMED PATIEN ~-ROPRIATE BOX) ‘
IS C] IS NOT
PHYSICALLY QUALIFIED TO WEAR A RESPIRATOR IN THE
PERFORMANCE OF HIS/HER JOB.
- PH
NYC-WTC_000120497
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NYC-WTC_000120497Source: NYC Law Department, mirrored locally