NYC 9/11 Public Portal Document
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ABATEMENT CONTRACTOR
PERSONNEL ROSTER Page /
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1. Client: 2. Project Name 13. Project Address: 4. Project Number:
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5. Aba meat ontractor: 6. Abatement Contractor Foreman: T presentative: 8. Starting Date:
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9. 11. 12 CERTIFICATE 13. 14. 15. DATE
SOCIAL SECURITY RESPIRATOR
NAME ADDRESS CAPACITY A. NUMBER TYPE
Agency B. Number MONTH: YEAR: c-' L_
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KEY: H: Asbestos Handler 1. Half face Air Purifying Respirator w/HEPA NOTE:
S: Asbestos Supervisor 2. Full face Air Purifying Respirator w/HEPA
A: NYC 3. Powered Air Purifying Respirator w/HEPA
B: NYS 4. Type C. Supplied Air Respirator (SAR) w/HEPA
C: Other 5. Type C. SAR w/SCBA
SPECIFY
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NYC-WTC 000129718
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