NYC 9/11 Public Portal Document
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interstate reciprocity among the Consortium of Northeast States.
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Certificate No. 3i 5 4 0 4
Social SecurityNumber: ........................
~tfame trainee ~signa3ure- " Telephone Number:
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Address::
P11
(Street or PO Box) - (City) (State) (Zip Code)
'H'= To be campFetect6K framing sponsor s ' =-~ "
Sponsors Name: - Telephone Number:
Address: ATC Associates Inc Zip Code:
104 Fast 25th S t. 212-353-8280
NYC, NY 10010 Course Location:
Course Title:
Language of Training: Q English Other. Exam Grade:
Dates of Training: From: _L1-l l To: JLiiLJL Expires:
I certify that the asbestos safety training course given on the above date complied with both 1ONYCRR Part 73
and TSCA Title 11, was consistent with the curriculum and instructors approved by they New York State
Department of Health, and the student receivin this certificate pompfeted the trainin cou a and successfully
passed the examination. ' /
Course Director:
(Printed) U (Signature)
DOH-2832 (7198) DEPT/ F LABOR
0
NYC-WTC 000121731
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