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,ECEIVED <br />RESPIRATORY PROTECTION AUG 10 29 130.20 R2 <br />ATTACHMENT A SAN JUAWIN COUNTY <br />OFFICE OF EMERGENCY SEF 130,20 <br />Qualitative Fit Test Report <br />Name.-4)��S /_ ✓; r _-ZA 1-42- Job Position: <br />Tested by: Date: o <br />RESPIRATOR: <br />❑1/2 Face Brand/Size ❑Chem Cartridge ❑Dust/Mist Filter <br />©Full Face Brand/Size ®hem Cartridge ❑Dust/Mist Filter <br />LIMITATIONS: <br />Explain <br />❑Beard ❑Glasses <br />❑Denture done <br />FITTING: <br />Satisfactory (Pos Press Test) _2'S'Satisfactory (Neg Press Test) <br />,Satisfactory (Irritant Smoke) ❑Unsatisfactory <br />COMFORT: <br />❑Very Comfortable ❑Barely Comfortable ❑Intolerable <br />Comfortable ❑ Uncomfortable <br />COMMENTS: <br />acknowledge having received respiratory protection training and I understand that my <br />use of this respirator must be in accordance wit' ' <br />manufacturers instructions. <br />7mployee Signature to <br />2 December 2003 6 Sierra Chemical Co. <br />