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RESPIRATORY PROTECTION <br />ATTACHMENT A <br />IECEIVED <br />AUG 10 ?* 30.20 R2 <br />SAN JOAQUIN COUNTY <br />OFFICE OF EMERGENCY SERVICES <br />FM 130.20 <br />Qualitative Fit Test Report <br />Name: ZOMJ 1A • L__&Zi OS Job Position: _CJLEVC4 MA kFt2 <br />Tested by: Cai y, Co n1 m ix u S . Date: <br />RESPIRATOR: <br />❑1/2 Face Brand/Size ❑Chem Cartridge ❑Dust/Mist Filter <br />Full Face Brand/Size N o (2,7 - OChem Cartridge ❑Dust/Mist Filter <br />LIMITATIONS: <br />Explain <br />❑Beard ©Glasses <br />❑Denture ❑None <br />FITTING: <br />,[Satisfactory (Pos Press Test) ©Satisfactory (Neg Press Test) <br />2Satisfactory (Irritant Smoke) ❑Unsatisfactory <br />COMFORT: <br />❑Very Comfortable ❑Barely Comfortable ❑Intolerable <br />Comfortable ❑Uncomfortable <br />COMMENTS: <br />acknowledge having received respiratory protection training d I understand that my <br />use of this respirator must be in accordance with company r rules an <br />manufacturers instructions. <br />x_9,5 _0 5 <br />E ployee Si nature/Date <br />ure/ e <br />2 December 2003 6 Sierra Chemical Co. <br />