NYC 9/11 Public Portal Document
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JOEL A. MIEL.E, SR., P.E. Comnilssloinf Deputy Commissioner
Bureau •o(
,ONE (718) Air, Noise, & Hazardous
'•.kX (718) Materials
APPLICATION FOR ASBESTOS INVESTIGATOR
CERTIFICATION
AND RESTRICTED ASBESTOS INVESTIGATOR
APPLICANT NAME:
HOME ADDRESS: -
CITY, STATE, & ZIP:
TELEPHONE NUMB
P11
DATE OF BIRTH:
SOCIAL SECURITY NO
PII
BASED UPON THE MEDICAL EXAMINATION WHICH INCLUDED
PULMONARY FUNCTION TESTS OF-VITAL.CAPACiTY (FVC)
AND FORCED EXPIRATORY VOLUME AT ONE SECOND
A-REGENTCHEST ,
(FEV1), AND AN EVALUATION OF
ROENTGENOGRAM, R IS MY OPINION THAT,THE ABOVE
NAMED PATIENT 1LEASE CHECK (4) 4PPROPRIATE BOX)
ig 1S NOT
• PHYSIC _I.Y QUALIFIED TO WEAR A RESPIRATOR IN THE
PERFORMANCE OF HIS/HER JOB. _....._ .
P11
NYC-WTC 000120463
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