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RESPIRATORY PROTECTION <br />ATTACHMENT A <br />RECEIVED <br />H S 1 Ad&i k2005 <br />SAN JUALIUIN COUNTY <br />OFFICE OF EMERGENCY SERVIC" <br />FM 130.20 <br />Qualitative Fit Test Report <br />Name: ��� � �, , �i�. (- r <br />� �' j Job Position: ,�%� <br />Tested by: 3 Date: /�05 <br />RESPIRATORY- <br />F-1112 <br />ESPIRATOR: <br />❑ J2 Face Brand/Size ❑Chem Cartridge ❑Dust/Mist Filter <br />[]Full Face Brand/Size Chem Cartridge ❑Dust/Mist Filter <br />LIMITATIONS: <br />Explain <br />❑Beard ❑Glasses <br />❑Denture E]f None <br />V <br />FITTING: <br />Satisfactory (Pos Press Test) OSatisfactory (Neg Press Test) <br />,jZj§atisfactory (Irritant Smoke) ❑Unsatisfactory <br />COMFORT: <br />❑Very Comfortable ❑Barely Comfortable ❑Intolerable <br />Lr 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 with company worqules and <br />manufacturers instructions. A <br />loyee Signature/Date <br />ate <br />2 December 2003 6 Sierra Chemical Co. <br />