NYC 9/11 Public Portal Document
' TKc cm or Na Yo uc Dewa r of &mw,t-srrw. PsOsbnon
c
ti t ~' JOEL A. MIEIE SQ.,,P1. Co., Iulooee ROBERT C. AVAITROrvr
Deputy Commissioner
Bureau•o(
Air, Noise, & Hazardous
Materials
APPLICATION FOR ASBESTOS INVESTIGATOR
AND RESTRICTED ASBESc'IOS INVESTIGATOR CERTIFICATION
APPENDIX A.
h1ED1CAL EXAMINATION FOR ASBESTOS INVESTIGATORS 1
APPUCANT NAME:
HOME ADDRESS:. I
CITY, STATE. & ZIP:
TELEPHONE NUMB
DATE OF BIRTH:
SOCIAL SECURITY
P11
BASED UPON THE MEDICAL EXAMINATION WHICH INCLUDED
PULMONARY FUNCTION TESTS. OF VITAL CAPACITY (PVC)
AND FORCED EXPIRATORY VOLUME AT ONE SECOND
(FEV1), AND AN"EVALUATION OF A RECENT CHEST
ROEKr(BNOGRh a, IT IS MY OPINION THAT_THE ABOVE
NAMED PATIEAIIjYPI FASF NC-r`KN) APRQPPIATEYOX)
Is
0 IS NOT
! Y9 .1 D TO WEAR A RESPIRATOR IN THE
s
K
NYC-WTC 000120534
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