ML19098A847

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Appendix J, Rad Health and Safety, Health and Safety, Asbestos Worker Certs - Dianapillajocerts
ML19098A847
Person / Time
Site: 07000371
Issue date: 03/01/2018
From:
Cabrera Services
To:
NRC Region 1
Shared Package
ML051740240 List:
References
Download: ML19098A847 (21)
v • d • e


Text

{{#Wiki_filter:Employee Name Current Asbestos License Curent Asbestos Training Current Medical Current Respirator Fit Test Other 10 Hour OSHA Polychlorinated B iphenyl Lead Awareness Conflned Spaces Fall Protection-Ladder Safety PPE, Ergonomics &,Hazard Asmt DIANA PILLAJO 6BAD0fi 4t23t2017 4123t2017 4123t2017 411212019 212U20t6 212112016 9124120t6 9124120t6 1012812016

State of Connecticut Print Lookup Details Name DIANA PILLAJO -., i" .i-.- illf ti.G,' f iH*nili't ,,,.i rlXi$.."..

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5t31t2016 Name License Information License Type License Number Expiration Date Granted Date License Name License Status Licensure Actions or Pending Charges Asbestos Abatement Worker r 1058 a6B0l20t7 0312112009 Diana Pillajo ACTIVE None Generated on: 5i3 112016l0:59:07 AM httos:/A,vrvw.elicense.ct.gov/Lookup/PrintlicenseDetails'aspx?cred=8'13136&contact= 1119920 1t1

Environmental Corrnpliance and Occupational Safety Training 44-flI21"st St, 3rd Fl, Long Island City, I{Y 1L101 Tel: (71S) 349-3235 F ax: (71S) 349-3238 HEREtsY CERTIFIES THAT DianaJ. Pillajo HAS COMPLETED A NYS DOH US EPA A}IERA 8 HOURS COURSE EN ITLED ASBE STO S WORKER-R.E]FRE SIilER (Spanf,sh) FOR THE PURPOSE OF TITLE 10 NYCRR PART 73 AND EP 40 FR PART 763 ACCREDITATION THE OF'FICIAL RECOR.D OF COMPLETION FOR THE COUR.SE IS TI-[E NYS DOH FORM 2E32 On this 23rd Day of April,2016 Expiration Date: 04/23/2017 I'tate(s) of coarse: on"t"o'\\^r,, n -.u),d \\.,, ?;:#';';:'firlil:;flrl*Nv-/'3 Director: Nicolas Portela [ \\ tto]i \\'\\.-'S \\ \\]"\\\\ih Exatm Grarle: *tb"l-

Med,icAl evaluation fOr. res iqato rotection 'ln=Co'mfi , lr--' -- I 9 1 0_. 1 31 Rpspiratgry Proteotion Standard and CFR 1926.1 1 0 l i.':'-' ' ((1f,)Q;MED, INC 44-Ai 2ist St. 3rd Fl. Long Island City, HY 111O1 tel.:(718) 349-3235 l'yqu provide in thls questionnaire is strictly confidential and Patient I os/eA - (:ji_ ,J J go (-J LU sa,/s e.-r

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'(.' Examination Have you ever had.aqy reipiratory problems: shortness of breath:/l L' chest paln: nO wheezing: '. ni-. If previously, when did you quit?.. How many per day?.....,, The above named individual has been informed of the increased risk of lung cancor attributable to the combined effects of smoking and asbestos exposure. .Based uBon medica! examination which included puln:lonary functier*1st it is nry opinion that the above named patient 1,s ) rs No' ,i,:- physically qualified to wear a respirator in the performance 9J. :'r':'ri his/hen job, "*l print name of pffiieian llL'l Do you use tobacco?..,.., O Currently O Previously @t'lever n;?S LR-#{/,t,{3} signature,, Wn*nh) ti, r lIfi \\f! MF se*:, 6 g- .--!..',..1,4.-r.-i

A LI T},LIE 1l lf U U^f sof"ty & Environmeniat rraining o consutting lnternational, lnc. QIIALITATNTE RESPIRATORY FIT TEST This Respirator Fit Test is valid for the period of twelve (12) months from the date of test. Diana Pillajo Name: 80 Woolsey St.

  1. 2 New Haven CT 06513 Address:

SSN: 551-69-8239 DoB: 6/1611979. rEL: (203I508iCI884 RESPIRATORS TESTED - SUCCESSFUL TEST l.'Irritant Smoke_ /

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3. Taste Test Test Agent :

HALF FACE MASK !_t BRAND NAME: (1) NORTH (2) ju 4t23t2016 TEST DATE: i Narne of person performing respiratory fit test Signature ONLY srzE (1) 042316-HF'.-CA - 0 4; FIT TEST NUMBER: ANp.S,tHternationai 44-01 21 st,Siree.i, #301 Long lsland City, IilY 11101 Tel; (7X&)'9/4S"gg,?S 44-01 Zlst Street 3rd Floor Lang Island City, NY 11101 c Tel: 7t8)349-3235 e Fax: (718)349-3238' www.andointernational'com Confesor Acosta .iii;.;l , t;.

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Training Gertificate Diana Pillajo Has successfully completed training course for Polychlorinated biphenyl ln accordance with 29 CFR {9{O.{20O Presented in West Haven, GT The 2{st Day of February 2015 signed,,4,f.{,M. Gertificate # 329-AlG -2211 5-{ SPGB

Training Gertificate Diana Pillajo Has successfully completed a training course for Lead Awareness ln accordance with 29 GFR 1926.62 Presented in West Haven, GT The 21st Day of Febru"ryr 2015 Gertificate # 329-Al G -0221 1 5-4

CERTXFICATE ffiF COMPLETTOI{ Diana Pillajo HAS DTLIGENTLY AND WITH MERIT COMPLETED TRAINNNG AND EVALUATION IN osr{A 29 cFR $ 1914J46 Confined Space Entry Operations September 24,2015 Diana Pillajo, Trainee 9241 5 18 Carry this wallet lD card at all times.) Maintain this certificate of completion with your training records for 5 years. National Safety Services, LLC, offers over 75 onsite safety training topics that can be combined to create unique programs to meet your training needs. For more information on these programs please visit us at www.atlS-af.sqlq (800) 804-7584 2, Turn eard over and plaee front of card face down into ffi CERTIFICATE OF COMPLETION Diana Pillaio HAS DILIGENTLY AND \\\\{TH }tERIT COIIPLETED TTLAu.NING.{ND E\\ALUATION lN S oslrA2gcFR$ l9to.l46 F Confined Space Entry Operalions g '9t2412015 ' oo r Fold and peel back at top riEtrt eorner.

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CERTEF'ICATE GF CGfuIPLE,TION Diana Pillajo E{AS DtrX-XGETNTLY AND WITH MERIT COMPTETED TRATNING AND EVALUATION IN OSHA 29 CFR $1910 Subpart D - Fall Protection OSHA Subpart X29 CFR 51926.1053 - Ladder Safety Septemb er 24, 2015 Diana Pillaio, Trainee 9241518 Carry this wallet lD card at alltimes.l Maintain this certificate of completion with your training records for 5 years. National Safety Services, LLC, offers over 75 onsite safety training topics that can be combined to create unique programs to meet your training needs. For more information on these programs please visit us at WWuf.nllSafu-qm (800) 804-7584 -l CERTIFTCATE OF COMPLETION Diana Pillaio H.{S DTLIGENTLY AND \\\\4TH I(ERIT COh(PLETED TNAINING AND E1ALUATION IN OSIIA 29CFR$ i 910 Subpart D Fall Protection Subpart X 29CFR0 1926.1053 - Ladder Safety 912412015 \\El i-J 5 (,l ca ,t /-,M,- (- mtNER Turn eard over and place front of card face down into Push card back \\ Fold and peel baek at top right eorncr. through clear

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Adam R. Drummond Diana Pillajo has diligently and with merit completed training and evaluation in osHA 29 CFR S{e{O Personal Protective Equipment, Ergonomics & Hazard Assessment October 28r 20{5 Diana Pillajo N ati o naf $afefy $erulces $afety Compliance $ulutions www.ntlsaf.com (800) 804-7584 Trainer October 28,2015 Trainee

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-Y Expiration Date: 0 5/0 2/20 I 6 C ertiJic ate # : 0 5 0 2 I SAItrRNY-I 2 Exam Date: 05/02/2015 Exam Gyade: '.-., . :...i,, Environmental Compliance and Occupational Safety Training 44-0L 21st St, 3rd Fl, Long trsland City, NY 11X01 Tel: (718) 349-3235 Fax: (718) 349-3238 HEREBY CER.TIFIES THAT Diana J. Pillajo HAS COMPLETED A NYS DOIIUS EPA AHERA 8 HOTIRS COI.]RSE ENTITI,ED ASBE STO S WORKER-REFRE SHER (Spanish) F'OR TIIE PURPOSE OF'TITLE 10 NYCRR PART 73 AND EP 40 FR PART 763 ACCREDITATION TIIE OFF'ICIAL RECORD OF"COMPLETION F'OR TIIE COURSE IS TI{E NYS DOTI FOR.M 2832 On this 2nd Day of tr{ay,2015 Date(s) of course: 05/02/2015 ,... :;:;:::l-aa......ffi,.: l.,i:liiii,. / ,:,:-',1ii.,,,y4,. ill'i; ' '."t,, 1il;1,;((l ' j.,.,'"'llli.,;r'$i,.r :..1 t,'i'. '.. li.,,'#i,,,-,l,l;,,,,.:';.

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TII:} T? Environmental Compliance and Occupational Safety Training 44-0l21st St, 3rd Fl, Long Island City, NY 11101 Tel: (718) 349-3235 Fax: (718) 349-3238 HEREBY CERTIFIES THAT DianaJ. Pillajo HAs coMpLETED A NysuoH uS EpA AHERAS HoURS couRsE ENTITLED ASBE STO S WORKER.REFRE SHER (Spanish) FOR THE PURPOSE OF TITLE 10 NYCRR PART 73 AND EP 40 FR PART 763 ACCREDITATION THE OFFICIAL RECORD OF COMPLETION FOR THE COURSE IS THE NYS DOH FORM 2832 On this 10th Day of May,2014 Exp ir atio n D ate : 0 5/ I 0/2 0 I 5 CertiJicate #: 0 5 I 0 I 4AHRNY-A 5 Date(s) af course:05/10/2014^, r \\\\ l, Director: Nicolas Portela \\\\ u u* \\'l-'S1 *i\\E \\A ExamGrade: fi $1.

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u't7 Environmental Compliance and Occupational Safety Training 44-0121st St, 3rd Fl, Long Island City, I\\Y 11101 Tel: (718) 349-3235 Fax: (718) 349-3238 IIEREBY CERTIFIES THAT Diana J. Pillajo HAS COMPLETED A NYS DOH US EPA AI{ERA 8 HOT]RS COURSE ENTITLED ASBE,STO S WORI(ER.RE,FRE, SHE,R (Spanish) FOR THE PUR}OSE OF TITLE 10 NYCRR PART 73 AND EP 40 FR PART 763 ACCREDITATION THE OFFICIAL RECORD OF COMPLETION FOR T}IE COURSE TS THE NYS DOH F'ORM 2832 FTII On this 19th Day of May,2012 Date(s) of course: 05/19/2012 Director : Tomasz Ch abowski Expiration Date: 0 5/1 9/20 I 3 Certificate #: 0 5 19 I 2AHRNY-L I Exam Date: 5/19/2012 ExamGrade: i..ii-t', ', ;{ ",1".. ,)".t"

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THE OFFICIAL RECORD OF COMPLETION FOR THE COURSE IS THE NYS DOH FORM 2832 . :, :'t. ',i11,, i1;1t l., .l:.:f L l,; i:.i;r'r,r Onthis 28th Day of May, 2011 ExpirationDate: 5/28/2012 Date(s) of course: 5/28/2011 '.,l ',, Certificate#:052811AHkNY-06 "r-),",'l,i

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Exam Date: 2/08n009 . I :,: ].,,jl,., ""r ,,.1,'.i, qr'\\ \\ '-):r\\ t ,,: r' Director: Nicolas Portela \\-tlt r.\\t,:(F,.ft" i,tl Exam Grade: '-ilL'l*, . a l' ffintIilru qfrr Emvirommemtml Cormpliance amd Occupational' Safety Trainimg 44-01 21st Street, Long Island City, NY 11101 Tel: (718) 349=3235,E ax; (718),349-3238 I{EREBY CET{TIFTES TIIAT Diama,'Fillajo IIAS COMPLETED A NY S DO}I/US EPA/ A.ILE.RA. 32 HOI]R COUITSE ENTITLED ASBE,STOS, IHANDLETT (In Spanistr) FOR THE PURPOSE OF TITLE 10 NYCFE PART ?3/ AND IIPA.4O C FRPART 763 ACCREDITATION T'I{E oFFICIAL REcoRD oF coMpLETroN clhurrs couRs[ Is rHE Nys DoH 2832 F'oRM OF' ASBESTOS SAtr'ETY TRAINING .,'*:i',#.,01i#1ii,;r:Smfi i{#tti#fe*Tf,i+ffi i,-1.: r t:,...- ; ,':.r:.r:r, rl jfiil}}

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