Document 5DqJz2Q1BDVGMby43x976LMGz

FILE NAME Mundet Cork MCK DATE 1963 DOC MCK119 DOCUMENT DESCRIPTION WC Claim of Goans Pt 2 STAIN UP ALRORSITA ALRORSITA INDUSTRIAL ACCIDENT COMMISSION COMMISSION a er APPLICATION PIEP SH.NIO ORIGINAL AND STX COFILs PLEASE PRINT OR TYPE NAMES AND ADDRESSES ADDRESSES CASE NO.3 CrP pecs of HOBER0T COANS www - 4732 - 25th Street San Francisco California California 1 LORENTZEN COMPANYCOMPANY and others ******** Social Security Nu me ~ . 1155 5th Street i SONATTD 'TREE Oakland CCalifornaia lifornia ARGONAUT INSURANCE COMPANY A. Fadcotnh A < . Los ares a, Robert Robert Robert Robert _. O. Goang Goang WAM woes + Se tewsan ee 9/2/00 9/2/00 ey 9/2/00 9/2/00 OWN wr **** California California St.rect St.rect * * * * * * * * **************** **************** ******** **************** **************** San Francisco California April alleges that while employed employed . April *** asbestog worker & **** **** **** **** **** Various ooo. woe Fees ae CRM insulation_mover insulation_mover CMT vow Various places THOR OF Cv ELE Hee wd faved Pate erery Cibfornis by seme eo _he sustained injiunrjyury sting sting out of and in the court af the empemplloyomentyment u follows Loc_many_years doing insulation Loc_many_years Loc_many_years INN rn mee nm KRYL^ KRYI L^ IR R muinas muinas muinas ** TS1 ve resulti ng resulting in www.www Chcumonochonlosla wwwwww PLATE CORE TASTE ammn e e RE HOSE BEFH sesuade one Bversovace veeryTa cme PL - cers me Various 3 ne ww * * emploper't iinjurynjury * OF 03944 * OR Ae fe a este Gy * AOS * * - aw ee was HEI NTE * Cen^ o 18 9945 the insurance carrier on date of 1. April 3 1963 present ** **** *** **** det ka ba serene 4 Wat compensation paid No | 740 KQ Escams at time of injury 1 Maximum Maximum @ & Wes medical medical treatment merdedi Yes an $92 ah se See we Java Co UPTO UPTO 66 TuemeyY 14 ROOD we caeme ve . bake that *** As Pu S - ********* ********* ********* eae Fu WIT wom ome are *** im *** *** lat ~~ oe eons ae HOES wes The boural boural pit was Atate Atate mai Fe 6s ws nevelt fore *** Ss wee at are at me a wied ?? Who furnished treatment treatment > - . oe a. **** ******* the **** ** LOOJAR LOOJAR ** *** SONY FGV First *** ** ***** **** 7. This applantion applantion is filed to determine Isability for # Tempmney disbulicy Yes Veo ec we * L^ngstunrap ou ** ** ** b Permancat dimbilty Yea ******* ******* ******* ame . c treatment Yc3 ate aw sy + ORES ** WINE 6448+ Medical Medical caus Fee come Mme ee vm we - 1 Pr Perwnen aa semegtnnniey 6 am Ue ste ss ne leo U2 * *************** *************** *************** ow *************** a *************** *************** be 9 & FILE fon Se ae a wee ~ WHERETORF in exquested that a time and place be fired for hearing and that an award be made granting such echef br proper under the Workmen'sWorkmen's Compensation Laws of California at maymay ver t Oakland wera Cilifonu 8. 1963_ . August 8. 1963_ ave Heating Heating orquested oorrqqueusteedsted Oakland Oakland | on : Number af sagri as // Rober0t. Goana 404712 A aidbe tb Hte Patrosund time of sul one half day Financial - oe SMITH 315 Financial PARRISH PADUCK & CLANCY Center Building Building Building Oakland 12 California Olencourt 2 2000 CEFO HEL be 'Henes wee FOCEE HEE toga 4043 ama sa ** we ARIE Ae Hd Het wisew ay Ore > Tere ae wey wary 001 EXHIBIT 82 .ee) Western Asbestos P.O. Box 3784 Hincon Anorx San Prancisco California Mundel Cork Company 410 Talbert Street San Francisco Francisco California Plant Hubber & Asbestos 1300 - 64th Street Oakland California Works Plant Astestos Company 1300 ~ 64th Street Emeryville U. California Army Port Contractos 3501 Maritime Street Oakland California Van 5th San Arsdale Harris Lumber and Brannan Streets Francisco California California Co. Bay Cities Asbestos Co. , Ltd. 6th and East 12th Street Oakland California Harry A. Dutton Jr. Dutton Asbestos Company 532 Natoma Street San Prancisco California California C. P. Braun & Company 1000 South Fremont Avenue Allambra California 10. Asbestos Company of Callfonda 94 A 16th Strect San Francisco 7 California 11. John Mansville P.O. Box 3784 Rincon Annex San Francisco Sales Corp. California California Marine Engineering & Supply 941 East 12th Street Los Angeles California Co. Armstrong Cork - 304 Slww Road So. San Francisco California 14. M. R. Carpenter 007 Pront Street Sacramento California California Cow Josulation Josulation 3600 - 20th Avenue Sacramento 17 California 16. Piberglass Engineering Engineering & Supply Supply 1200 17th Ste"k Can Danciuco Danciuco Danciuco California California Owend Corning Corning Fibergla Cep 1200 - 17threet 17threet San Francisco California PERIODS 1926-1943 1940-1950 1940-1950 1903 1903 and others 1955-195 - 1937 1990 and others 1940 1941 1962 3941-1948 and other 1907, 1999 1960 and others 1941 and 1947 and others 1942 and others 1944-1946 and others 1941 1964 and others others 1938 and thas 1944 and 1995 and others 1949 and 1950 and others others 1938 1950 1956 1994 others 19955 1967 and 1990-1993 1990-1993 other other 1959 1960 and 1950 1961 and 1962 und others others 1963 1964 and others 1995-1996 1995-1996 bbe, 1961 1969 and 002 ( ! ) oo EMPLOYERS EMPLOYERS EMPLOYERS Charles Ayres Company 698 Minnesota Street San Francisco California 1955 1957-1959 and others Ceast Insulation Froducts Froducts 2316 San Fernando Hoad Los Angeles 65 California Thomas C. Douglas Jr. Douglas Insulating Insulating Company 2233 Ingalls San Prancisco California J.T. 1351 Thorpe & Sons Ocean Avenue Emeryville California 1956 and others 1956 and others 1969. 1900 1957 and others Armstrong Armstrong Contracting & Supply / Armstrong Cork 304 Shaw Road So. San Francisco California e 1958 and others 23. National Insulation Inc. Inc. 503 Polk Street San Francisco California 1962 and others 24 Lorentzen Company Company 115 - 5th Street Oakland California 1955 1962 and others 75. vey 75. Jac oon Hopi ins P.O. Box 490 Company Inc. 1957 and others Bakersfield California California 20. 20. Kelly Asbestos Inc. 2030 Grand Avenue Kansas City 8 Mo. 1949 and others Asbestos Products Inc. 710 Raymond Avenue St. Paul 4 Minnesota 1949 and others State Compensation Insurance San Francisco California California Pund 525 Golden Gate Avenue Industrial Indemnity 300 Grand Avenue Oakland Actna Casualty Insurance California Company 1130 Broadway Califonia Oakland Travelers Insurance Company California 1956 Webster Street Naldand American MoLoristo Rusa building San Francisco Colifornia Colifornia AFrrgaonncaiustcoInCsaulriafncoerniCaompany 550 California Sureel San Standard American Accident 43 California Street San Francisco Calif Imployer HES Pilding San Penuelace California Haria & Brophy 1590 San Pablo Oakland California 003 e PROOF OF SERVICE BY 1013"2015.5 C.C.P. ) STATE oF ORTANEDA COUNTY OF ALAMEDA | 39 39 I am a resident of aforcoald county not a party to the 1 the United States I am over the age and a resident of of eighteen years the and within above action my business adiress 315 Financial Center Building Oakland 12 Califorata AUG 1963 On (eh S snp | Va 2 eemeratie $$ I served the within AMENDED APPLICATION on the various parties in cald action by placing a true copy thereof enclosed in a sealed envelope with postage thereon fully prepaid in the United States post office office aall box al Oakland California addressed as follows Western Asbestos P.O. Box 3784 Rincon Annex S.F. Munlet Cork Company 410 Talbert Calif Plant Rubber & Asbestos Street 5.F Calif Plant Works 1300 + G4th St Oakland Calif Asbestos Company Arme Port 1300 + 64th Street Emeryville B Calif Van Contractors 1501 Maritime Street Oakland Calif Arsdale Jarris Lumber Sth and Brannan Sts S.P. Calif Bay Cities Asbestos 6th and East 12th Hary A. Dutton 532 Natoma St. S.F. St. Oakland Calif Collf C. '. BrauCn o. " 1000 So. Premont Ave. Alhambra , Asbestos Co. of Calif 941 AM 16th Calif John Mansville Street S.F. Calif Marine Marine Sales P.O. Box 3784 Rincon Annex S.F. Engineering 941 East 12th Street L.A, C3110 Calif Armstrong Cork 304 Shaw Road So. S.P. Calif C3110 M.N. Carpenter 907 Front Street Sacto Calif Caw Insulations 3600 ~ 20th St. Sacto Calif Fiberglass Fiberglass Engineering 1200 Am 17th St. S.F. Calif Owens Corning Fiberglass 1200 - 17th SL S.F. Cal~-r Charles Ayes Co. 698 Minnesota St. S.P. Calir Coast Insulation 2316 San Pernando Rd L.A. Calif Thomas C. Douglas Jr. 2233 Ingalls S.F Calif J.T. Thorpe 1351 Ocean Avenue Emeryville Calif Armstrong Contracting 304 Shaw Road So. S.P. Calif National Insulation Inc. 503 Polk SL S.F. Calif Lorentzen Co. 1159 - 5th Street Oakland Calif Jackson Hopkins Co. P.O. Box 490 Bakersfield Calif Kelly Asbestos Inc. 2030 Grand Avenue Kansas Asbestos Products 710 Haymond Ave. St. Paul City A s State Compensation Insurance Fund 4 Minu 525 Golden Gate S.F. Calif Industrial Indemnity 300 Grand Ave. Oakland Calif Astna Casualty Insurance Company Travelers Insurance Company 1956 1330 Broadway Oakland Webster St. Oakland Calif American Motorista Russ Building S.F. Calif Calif Argonaut Insurance Company 550 California St. S.f. Standard Accident 433 California St. S.F. Calif Calif American Employers Russ Building S.F. Calif Hanna & Brophy 1500 San Pablo Oakland Calif 1 certify certify under penalty of perjury perjury perjury that the foreforgegoing oing is and correct AUG 9 * Executed on 1963 at Oakland CalifonlCalaifonla true //Sharon McKay The proof of service by mail form of perjury does not require notarization being signed notarization under penalty 004