NYC 9/11 Public Portal Document
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• ABATEMENT CONTRACTOR
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1. Client: 2. Project Name 13. Project Address: I4. Project Number:
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5. A atemerd Contractor: 6. Abatement Contractor Foreman: ATC epresentative: 8. Starting Date:
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9. 1 '. 9 11. 12. CERTIFICATE 13. 14. 15-
SOCIAL SECURITY RESPIRATOR
DATE
NAME ADDRESS CAPACITY
A.
Agency B. Number NUMBER TYPE MONTH: l C YEAR. '-
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3 i '2) 3 4 5 6 7 8 9 10
11`-12 13 14 15 16 17 18 19 20
O S C. 4 5 21 22 23 24 25 26 27 28 29 30 31
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p _ v S C. 4 5 21 22 23 24 25 26 27 28 29 30 31
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1, 2 3 L2' 3 4 5 6 7 8 9 10
11 12 13 14 15 16 17 18 19 20
, S C. 4 5 21 22 23 24 25 26 27 28 29 30 31
KEY: 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 000129719
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