NYC 9/11 Public Portal Document
CITYOFNEW YOF
DEP
DEPARTMENT OF ENVIRONMENTAL PROTECTIC.
BUREAU OF ADL NOISE AND HAZARDOUSNATERLAL
ASBESTOS AND LEAD CONTROL PROGRUM - TRAINING AND CERTIFICA TION UI.:
32-12 JUNCTON BOULEVARD, 6 TH FLOOR CORONA NEW YORK 1136
APPLICATION FOR ASBESTOS INVESTIGATOR
AND RESTRICTED ASBESTOS INVESTIGATOR CERTIFICATION.
APPENDIX A
MEDICAL EXAMINATION FOR ASBESTOS INVESTIGATADC.
APPUCANT.NAM
HOME ADDRESS
CITY, STATE, & ZIL
TELEPHONE NUM
DATE OF BIRTH:
SOCIAL SECURITY
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 EVALOATION OF A RECENT CHEST
ROENTGENOGRAM, IT IS MY OPINION THAT THE ABOV
IAMED PATIENT IPLEASE CHECK NLAPPROPRIATE BOX
IS NOT
PHYSICALLY QUALIFIÉD TO WEAR A RESPIRATOR IN THE
PERFORMANCE OF HIS/HER JOB.
PII
NYC-WTC_000120501
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NYC-WTC_000120501Source: NYC Law Department, mirrored locally