ML19098A846
| ML19098A846 | |
| Person / Time | |
|---|---|
| Site: | 07000371 |
| Issue date: | 03/01/2018 |
| From: | Cabrera Services |
| To: | NRC Region 1 |
| Shared Package | |
| ML051740240 | List: |
| References | |
| Download: ML19098A846 (14) | |
Text
{{#Wiki_filter:Employee Name Current Asbestos License Current Asbestos Training Current Medical Current Respirator Fit Test Other 10 Hour OSHA Confined Spaces Ladder S afety-Fall Protection PPE, Ergonomics &,Hazard Asmt PIT-Forklift Operator Aerial Work Platforms JOSELITO FLORES rcBU20t7 4lnDarT 4lr4l20t7 71712017 912412016 912412}rc t012812016 51212019 sl2l20r9
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,.S:-Lu,id.1,.. rfu -;: ".;ir*i 1Di{1qtfnq' Lookup Detail View Name JOSELITO R FLORES License I Expiration I Granted I License Number loate loate IName 10t31t2017 I rnatzoto I JosEllro R FLORES License Status ACTIVE License lnformation lookup License Type Asbestos Abatement Worker Generated on: 31912017 9:37:28AM Licensure Actions or Pending Charges None https://www,elicense.ct.gov/Lookup/PrintLicenseDetails'aspx?'cred=1388582&contact= 1535M6 1t1 Name
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New York City Departrnent of Environmontal protection Asbestos Control Prog ram 59-{ 7 Junction Boulevard, 86 Floor Flushing, New York 11373 Application for Asbestos Appendix A I&OpatExemination fgr Appricanr Name: dCfeliro Re rr. F r HomeAddress: FO lt )frt/ re.f <f #1 Ciry. Stato andZrlpcooe: l/Zh) r4flU?m Cf daf/S Terephone Number: t2O3t 654-558L Date or Birlh: /D/q/jv ?*i ,iii;[ii ir.;r; ii] 4.. Soeiatsecurity Number: 7^,gL-- q / 6 ? E--l r^ri '.r" iI ". Baseci upon the mecjical oxamilraiion whicir inciuoeo puirrronary iunction lesis of vital capaciiy (FVC) and lorced expiratory volume al one second (FEV1), and an evaluation of a recenl chest roentgenogram, it is my opinion that the above named patient (please check appropriate box) fl is nol physically qualified to wear a respirator in the performance of his/her job. Limitalions: ,k,.,$B/*; f, \\t-'+" tB+ 566 Slate Llconse Number Pleaso do not lnctude any olhor m8dlcal lnformauon wilh lhls form. Dr.AhoRoEo d&t87{&8t Brfitlrst N.y.llgt3 Llcanro$l8iZ5B0 trPr2SiFB{S{ r r6 qSB 15 t5 Tolcphon Number t gd.lld 122006 .t{o q6 TY # i\\fiftsE-_=.-=-.-'
F[;i#;:b6nn6[i ilenai ssance II sTtt: 'G-030700944 Vers'ion: 1.1.11 SPIRS,IE]RY REPI}RI BEST FVC/FVL REPORT )e55 lUll lllllU' u/'!'v'-ur Iasi cat Check: 04APR2016 ID: Name: Gender: Med i cati on : Dosage: Cl'inical Format: 10191967 FI ORES JOSEL]TO R HALT PREIiED - 07:36i{! Best Criteria: Heiqht: 66" Aqel 4BYRS H6iqht: 160LBS Snnker: 20YRS' 1 Ethni ci tYlCorrection : VAL LLN 2.9L 2.5L 72 Sensor Code: 051442 TemPerature: 52F Barbnetric Press: 760nrnHg BTPS Correction: 1.1!1 100.01 Normals: KNUDSON 83 < Indicates Below LLN Physi c.ian: Techni ci an : Pack Yrs CAUCASlAN HEA5I'RB4EIIT FVC (L) FEV1 (L) FTVH FEr25-75 (L/S) PEF(L/S) FET (S) gE F F BEST 4.54 3.75 B3 3.66 I.01 4.38 SPred 114 115 100 105 110 Pred 3.97 3.26 B3 3.41 8.12 Tri al 1 L l 1I 16ML PEF VAR: 265M1/S Reoort SunmarY: P.6-ll"O' l-esls 2 AccePLable 0 ATS InterPretation: Lung Age: 48 YRS Corrnent: 14 12 LA Reproducible 1 FVC VAR: l27l4L [EV1 VAR: PREMED - Normal SPiromettY LtiFo-iii.r o[ If stoP snoking: ou B 6 4 2 a 6l zl 'l 5l 4. J 2 1 a tl, J a-tlr a J lt tJ ul Ei "l FI L J
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Respiratorv Fit Test Record Employee Name: Social Security: '/l cl Location: PIKE FALLS 16 HAMILTON STREET WEST HAVEN CT 06516 Location if Different then Above: Date Tested: circle one Te st Re s u ttrsiFaislra i t Type of Respirator: Racal PAPR (under Negotive Pressure) restResu,@]rt, Other Types of Respirator: Test Results: Pass I faif Employee Signature: Administrator: Type of Test: lrritont Smoke Qualitative Testin,q Type of Respirator: North % Face (7700-30 s Date: {, T fa Date: 4
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CE,RTEFTCATE OT COKItrLE,TTON Joselito R. Flores E{AS DII-IGENTLY AND W^ITH MER.IT COh{PI.ET'ED TRAII{ING AI{D EVATUAIION IN osHA 29 CFR $ 191 0.146 Confined Space Entry Operations Septemb er 24, 2015 Joselito R. Flores, Trainee 924L517 Carry this wallet lD card at all times.) Maintain this cedificate of completion with your training records for 5 years. National Safety Services, CERTIFICAIIE OF COMPLETION Joselito R. Flores T1AS DILIGENTLY AND \\\\1TH I{ERIT COTIPLETED TRAINING AND EVALUAT'ION IN S osHA2gcFR$ 1910.146 5 Confined Space Entry Operations g 9rz4/zor5 ' { LLC, offers over 75 onsite safety training topics that can be combined to crea unique programs to meet your training needs. For more information on these programs please visit us at wUryU.tlls-af.qo-m (800) 804-7584 ffi 1. 2-Turn card over and place front ol card face down into clear panel. =r-@ Push card back \\ Folcl and pecl back at top right eorRer. through clear
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CERTEFECATH, ffi F Cffi h,flElLETIOh{ Joselito R. Flores F{AS DILIGENT'LY AND WITF{ MERIT COMPI.tsT'ED T'RATNTNG AND EVA.LUATION IN OSI{A 29 CFR $1910 Subpart D - Fall Protection OSHA Subpart X29 CFR $1926.1053 - Ladder Safety Septemb er 24,2015 Joselito R. Flores, Trainee 92415L7 Carry this wallet lD card at all times.) Maintain this certificate of completion with your training records for 5 years. CERTIFICATE OF COMPLETION Joselito R. Flores H.AS DiLTGENTLY AND \\VITH I\\1ERIT COITPLETED TIL{INING AND E\\ALUATION IN OSI{A 29CFR$ l9l0 Subpart D Fall Protection Subpart X 29CFR$ 1926.1053 - Ladder Safety 9t241201s \\o I,J 5 Ur{ National Safety Services, LLC, offers over 75 onsite safetytraining topics that can be combined to crea unique programs to meet your training needs. For more information on these programs please visit us at Wlyt^LnllEAf.EAXn (Bo0) B04-7584 1' -.fl\\. 2' /*,- \\r Fotd and ffi rrJi,"n./ I \\ right L l* corRer. Turn eare.l over and plaee front of card faee dewn into ,/.-)<:J^ Push card back through clear
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Joselito R. Flores has diligently and with merit completed training and evaluation in osHA 29 cFR S{9{O Personal Protective Equipmentn Ergonomics & Hazard Assessment October 28r ZOis N ati o nal,$afefy $erufces Satety Cornpliance $olutiorrs vwwy.ntlsaf.com (800) 804-tig4 Adam R. Drummond Joselitonffi Trainee Trainer October 28,2A15
CERSEFECAEE ffiF CffifuflPtffiTEffiN Joselito Flores F{AS DIL{GENTIY AND WXT'H MER.IT' COMPI-ETED T'RA{I"{TI{G AND EVATI]AT]ION IN osllA 29 CFR $ 1910.178 PlT-Forklift Operator May 2,2016 This certificate of training expires 3 years from date of haining Safely Compliance Solutions 5021604 Joselito Flores, Trainee Carry this wallet lD card at alltimes.* 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 creat unique programs to meet your training needs. For more information on these programs please visit us at u/lyry-nllsefeqm (800) 804-7584
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Turn card over and place front ol card {aee down into clean Banei. 4. ./\\/t\\ ffi t. CERTIF'ICATE OF COMPLETION Joselito Flores I TAS DILIGENTLY AND \\VITH }IERIT COTTPLETED TRAINING AND E\\ALUATION TN osHA2gcFR$ r9lo.r78 g PIT-Forklift Operator S May 02, 2016 S This card expires 3 Years fiom date oftraining a azZ - c-mtNER "1-\\ ' dJ_ Fush card back \\ Fold and peel baek at top right eoflner. through clear
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EffiRTEFSCAEE ffiF CffifuflPLH,T{GN Joselito Flores HAS DTI-XGEhITLY AN]D WTTF{ MERIT EOh4PI.ETED T'RAII{ING Ah]D EVALUATION IN OSI{A 29 CFR 51926.4s2 &,4s3 ANSI A92.5 8L A92.6 Aerial Work Platforms (Scissor & Boomlifts) rhis certincat" "rn",Yll3:.19]al6s from date ortraining Joselito Flores, Trainee so2 1604 Carry this wallet lD card at alltimes.* Maintain this certificate of completion with your training records for 5 years. CERTIFICA-TE OF COMPI-ETION Joselito Flores HAS DILtcENnY AND \\\\.lrH l!(ERlr COT{PLETED.TRAININO AND EVALIJATION lN osHA 29CFR$ 1926.4s2 & 453 ANSI A92.5 A92.6 Aerial Work Platforms (Scissor & Boom Lifts) slo2t2ot6 This card expiles 3'Years from date oftraining (,r b.J o\\ ,L National Safety Services, LLC, offers over 75 ortiL" safety training topics that can be combined to creal unique programs to meet your training needs. For more information on these programs please visit us at w!Y!y.n!lEe-[.c!-!1 (800) 804-7584 Turn earel oven and place ,/ frsnt of eard face dswn into / *j-Push card back through elear
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