FIRE DEPARTMENT, CITY OF NEW YORK * BUREAU OF FIRE PREVENTION access # CERTIFICATE OF FITNESS APPLICATION -S PLEASE PRINT ALL INFORMATION CLEARLY ENTER TYPE OF CERTIFICATE OF FITNESS APPLYING FOR ceRmnICATE NUMBER ASSIGNED ass: I ‘The Supervision of Chemical Laboratories (C-14) _ Fororriciatuscomy a tastName MANTLE First MICKEY mil sse 444668899 HOME ADDRESS 300 BROADWAY ner 81 city NEWYORK state NY zip 10034 experience [7] pracricat__exeertence vears © _wonrns_§ pate or eigrH_€/10/1980 SEX MALE WEIGHT 125 HEIGHTFT 5 INCH 6 EYECOLOR BLUE HAIR COLOR BROWN FALSIFICATION OF ANY STATEMENT HEREIN IS AN OFFENSE PUNISHABLE BY FINE OR a | ‘21 PREMISES RELATED IMPRISONMENT OR BOTH (NYC ADMINISTRATIVE CODE , O.C. SECTION 1151-9.0/N.C. 10-154) |, MICKEY MANTLE request issuance of a EMPLOYER NAME Certificate of Fitness as a Laboratory Supervisor (C-14) on the basis of COLUMBIA UNIVERSITY PHD in BIOLOGY and 6 years of 601 WEST 168 STREET experience in Laboratory Facilities. NEW YORK, NY 10032 | will be employed at Columbia University and have been trained in the University Laboratory Safety Plan, 3RCNY, Chap 10, Fire Alarm and Evacuation procedures and Fice Extinguisher training. APPLICATION MUST BE SIGNED x TO BE PROCESSED! DATE de COLUMBIA UNIVERSITY IN THE CITY OF EW YORK Environmental Health & Safety To whom ft may concern, {1am pleased to recommend MICKEY MANTLE 0 apply for a Certificate of Fitness as asa Laboratory Supervisor, The applicant has PHD in BIOLOGY and 8 years of experience The applicant will be employed at Columbia University. The applicant is of GOOD CHARACTER and is PHYSICALLY ABLE to perform the functions required by the Certificate of Fitnes holder. The applicant has been trained in 3RCNY, Chap 10, Fire Alarm and Evacuation procedures and Fire Extinguisher usuage. Paul Rubock Director Biological Safety Programs, Associate Director EHS TESTRESULT PASS: DO NOT WRITE BELOW THIS LINE CHECK HERE IF N/F ACCOUNT Bio. EXAMINER'S SIGNATURE ue EXAMINER'S IDENTIFICATION NUMBER I 1A20 (394) 96-940040 914