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RESPIRATORY PROTECTION HS13A R2EVED <br />ATTACHMENT A AUG 10 20 <br />�OGINE = M <br />Qualitative Fit Test Report <br />Name: r _, Job Position: d -- <br />Tested by: Date: <br />RESPIRATOR: <br />❑1/2 Face Brand/Size ,,hem Cartridge ❑Dust/Mist Filter <br />BFull Face Brand/Size A M P T /zl� Cem Cartridge ❑Dust/Mist Filter <br />1 IMITATInNS- <br />Explain <br />❑Beard Glasses <br />❑Denture ❑None <br />FITTING: <br />isfactory (Pos Press Test) Oatisfactory (Neg Press Test) <br />atisfactory (Irritant Smoke) ❑Unsatisfactory <br />f`f'%RA Cf1CT• <br />vvnn v�.. <br />❑Very Comfortable ❑Barely Comfortable ❑Intolerable <br />Comfortable ❑Uncomfortable <br />f`nU M GnITQ <br />I acknowledge having received respiratory protection training and I understand that my <br />use of this respirator must be in accordance w <br />manufacturers instructions. <br />Employee Signature/Date <br />2 December 2003 6 Sierra Chemical Co. <br />