Document KGo9mXQ4Ljbymjqbnjjb77Lx0

FILE NAME Mundet Cork MCK DATE 1978 DOC MCK144 DOCUMENT DESCRIPTION WC Claim of Swartout Pt 1 ontfydh stn Ne artf . : A " an Stampersz StampersStazmperesze Reed MRA EXK CALIPTG~CALIPITG~AIA (ONC? NICHOU CALIPTG~IACALIPTG~IAYS DEF NICHOU STREN^ .. POR SA1^00MOIYO 5 Road COUNTY tr COUNTY ONLY DYAYE OF CALIFORNIA SAPARTSHAPARTOHONYNOYF INDORYBIAL RELATIONS \ INDUSTRIAL ACCIDENT COMMISSTON \ D^ THISSPACE IN . _ 70 |~ ILED 55 CALIPOMUTA BDI STETH STETH WHEN F B APPLICATION FOR HEARING : ILED NEC SF ut ILED ILED PO waeder t . Employer's John Swartout Social Security Ne Nime of : , 3 Employa 472 - 10 --- : 9896 ^' . Yomi ress 1% ; 2. Name of 4 P. Tantrisca Carrier _See attached 116 4 Employeto 3000 Merrywood Merrywood Merrywood Drive Secremento 17 RempRlempoloyyer'ser's eCralieforni0a8CSa^lifornia . companiecomspaniecsompanies ; TRENT LES companies B Learance 5459 9 4 As Carrier's Addres texeg Californis State STEP Oeedt And aonary What 3 . HP tear STAYE . Employee's name John SkarZQU^ a Employer's date % Oute of Employer's bink September 5 1889 occupat^>na n Plan wheyoruer injury oEfxpotsimuere Qver a long periodperiod Employer's Employer's injury ASBESTOS Insulation 3 ? Injury escorrado California When did you leave work Insulation a NE gre Beery . Br How did injury seedorking with asbeston za seralt of thi.s January 6 1955 : injord Asbestosia " . renrock off Ho Whea you Stil Full or part time work Blt time work Your wages or salary before per If prid on kourly rate how deductions . 1.3.15 weekhourhour 1.3.15 weak per sometimes sometimes per Did many hours did yoy work per week or overtime woontk overtime you receive any of the following Board Yes No (Or Lodging weekly valus YONQ Til Nordagut Nordagut a State their YONQ You Nordagut . Nordagut Nordagut Yes E Moly ge Nordagut Jobs Have you bom poid any competion Yes Ne How much 910.00 on some Date when last was made 135.00 135.00 payment Up to Sept. 13 910.00 Weekly rate of payment Has the employer or the insurance carrier furnished Datewhen laat matzokat was given Sept. with any medical } No B 16 of furnished List names alldoctor who have trinted you and who was furnished Have you obtained any medical treatment at Line namos of all doctors who have your free spoon or Dr. Webster Saermento Hospital expense.Dr Fortier Clinte treated Hospitals by the employer employoerr insurance carrier YaII D expense.DrFortier with Saermento Hospital Dr. Clinate t Allan Springvale Moe any of Are Temporary the following beachite Antwer w 1 Temporary disability payment e Further medical tiestment_ Yax Yen Yo No b Permanent ve of disability payment Yes c List ether benefits claimed andnot mentioned mentioned abov d youyorur medical medical Yes SpringvaSprlingveale Saoto a Have you ever before filed a claim with this Comminim Ye NoIfn who was filed MITE newvestera ktur a^ frvzoAZY DON KILOMET KILOMET 1616 Financial Financial MER Financial mt Center Ve lifornig lifornig Bldg GLENCOURT GLENCOURT 2-2000 ng TELAYAN TELAYAN Karlipot smartparing ANIWKAL Nad 6/22/56 of Ltaalbenot r fomulibad kama smartparing Sadammture smartparing smartpsmartaparingriimpnergialis filpeaoilsinotsotratmomre mishia A19cdahysoolffiofoff f of the f All Parties - Din the sieties 607 to arched co^sdag of ska shu^a and place of bepules Ridatputty kay bap talent tab lent y fo fomulibad for shot kam W bepules mokesco kad unas bacut^tn th">pt VE PLAINTIFF EXHIBIT CCS 5143 d John E. Swartout Asbratos Sickness -= Asbosto Asbestos Companies for whome he worked 1905 to 1939 -- Companies in Minnesote and 1 your in New Mexico - these are in office files of John Lio Lewis Job locatior 1940 S. R. Dutton Co. Western Asbestos 4 months July Sopt Oct. Co. - Nov. and Dec. S.F. S.F. 1941 to Nov. 1947 Western Asbestos Company S.F. 1948 Away from this work for 6 mos Bxby 5} BY) . Approx 1948 My Cities Asbestos Co. Onkland 3 09 Neh Western Fiberglass Supply S.F. 2 H Stockton Calif Stockton and General Insulation Co. S.F. 1 mo Watsonville Prosno TERMS 1949 General Insulation Co. PHENN 1009 Stockton Sc Armstrong Cork Co. ramet Western Asbestos Co. PHENN by Stockton 1 J.T. Thorper & Son Inc. PHENN mo PHENN Ft Livermore Hosp PHENN The Asbestos & Magnesia Co. Watsonville L Materthicago Materthicago Casper Wyn ~ Materthicago Materthicago Asbestos Supply Co. of Seattle 5 mos Fairbanks Alaska 1950 C. C. Moore & Co. S.P. . K. Carpenter Sacto Phillip Carey Mig.Co. Mig.Co. Cincinnati Armstrong Cork Co. of Lancaster Pn 2132 mos 2132 " 2132 it Carlsbad N.Mex.- Sacto Pittsburgh Pa 1951 1952 1953 1954 1955 Armstrong Cork Co. Tacoma Asbestos Co. of Tacoma Olmen Co. of Chicago Anch#orage Alaska - Terre Haute ind Jamar O. of Chicago Johns Manville M ue Trenton N. J. Phillip Corey Mfg Co. insulation Services of Minn Paul manville nes jorp Huntington W.Va. I Terre Haute Ind Indianapolis Ind ///// ///// t ///// Insulation Services of Minn Hunter Mfg Corp. of Bristol PA M. ArmRs.troCnagrpCeonrtkerCo.SaocftoLancaster Pa Western Asbestos Co. of S.F. 4 mos 2 #t 1 mo 2 mos 3a tt Torre Haute ~. Tuscon Ariz Spokane Wash Sacto Porterville Cal Armstrong Cork Co. In January of 1955 but became 111 Jan. 10th ap and left job Went into hospital Jan. 17th of . a eTave or CHAP HHTA , phere DESH D MORTHTRM IBDCEPT L^ GAN Poe PDA PDA CALIFORNI~ TeACERT IBDCEPIBDCTEPT IGION OBA Hise se haw DAH FARCI ov STATE OF CALIFORNIA STATE DEPARTMENT DEPARTMENT OF KILATIONG INDUSTRIAL POR RECEPPLIC ELCRAMENTO POR ELCRAMENTO No 100 100 Hoge BAGAAE BAGLAMENTE COUNTY AET RECEPPLIC RECEPPLIC DOUTHERN ROUTF( ORDOUTHERN PAN DIBAS (raGzev RECEPPLIC FOR COMMISSION APPLICATION FOR LA SOt Brae STATE FOR SAN worURFRASKB F1 O9 RFouNTH Gani Osneed + Want DIVISION Want Want DIVISION DIVISION i lok wat INGAISTHEAL OF Cao 169-171 po wot WRITE THIS ERAS. fF) shag BL Be DO NOT WRITE WRITE awiat THIS S: PACE CP wal FILED AIS JUN 13 1956 Nesoor Nesses Nesses Addcomes of Applicsnurt eriany 3000 Applicantu prive te a mn Sacramento Sacramento Merrywood Drive Drive Name Employer Listed Name Name ListedListed separate sheet 1955 as filed December December , ete ee as re attached listas Address Address InsuranceCarriers See omens list list nibh 28 Plame of Larernnce per per December 1955 oa SY eaeeaenrrsinstantann dua e k py mot Employers John & aw September Birth 1956 tame Date Date employer's Emp Swartout Swartout Ma1 x 951886 9 tae occupationAsbestos worker worker injury jobs J Employe's ocupationAsbestos worker occurreds Employee's EmpElmpoloyyeee'se'soccupationAsbestos occupatiooncAcsubpesattoisonAsbestos occupationAsbestos occupationAsbestos e e time occupationAsbestos Asbestos What injury employee employee Shar work was employee doing ax hime time Date of Employee's September , 1889 1 it Dite employe's Max 30 employee's employee's Place where Insulation work Various Inne ae nem ne monneernere Mere yvolved? Yes Fl No Amount paki - eanemee ar Was Was compensacompenstationicomopensnationpaid the the Ya Ifso how much much . whitUN If LCliisnitc Cmliinisc sdmeisossesctora doctors tested Specialists employer employer after after his lungslat RespResprre Reespre Respre Respre FFaarrrisrtiomastoe Afllan whit whhiitt ut Clinic expeburialnexpenees dsoctora doctora Yes Specialists Springville Allan doctora Specialists on lungslat His burialexpen bees Dr Robert , Has pid? Yo C] Ne CE Yes how much . " oo Liar all chose eho NAKE Mr, John E, Suartons 3000 Sacramento Merrywood Drive Mrs. TO Wife EMPLOYEC have tev if AGE AGE RELATIONSHIP RELATIONSHIP RELATIONSHIP injury injury EMPLOYEC Swartouk Swartouk at ADDRESS Wife Wife ane Sacramento _emnumcnme rennte ee A r mel ee nan nl IMPORTANT for Appointment Reason it the years Commission Commission for Appointment Forms ts wadet 21 Yeare Industrial Industrial Industrial Accident Accident CommissioCnommission any appticanc the offers of the Tnduecrial Accident spplicationt spplicationt at Reason for filing this spplicationt Guardian Liv ed iv Ruwoe (et SMITH this PARRISH - Attorneys Attorneys Law -501 Financie Center Dakland Dakland California Financie L Center Center Dakland GLencourt California California 2-20002-2000 a GLencourt GLencourt Dakland, California Bldgs En wolfersken th^ laborelal Mray Mray Mray Swart John , AACN OF BEFITS DATE ARTIC ARTIC mero hiemandy pepet t own ce rurin All All All All 6/22/16 6/22/166 /6/22/162/61/622/61/262/16. .& AbolAllAlll 6/22/16 6/22/16 6/22/16 sha annie All RATS SL 6/22/16 T PARR TS. b/sye fst, PLAINTIF~ SPLAINTIF~ S KXHIBIT_ | Said State of California gt we INDUSTRIAL ACCIDENT COMMISSION 965 Mission Street San Francisco BR m JOHN E. SWARTOUT ^B ^B Applicant MUNDET CORK CORPORATION et al Defendant ee Claim No. 55SP 169 171 ill NOTICE OF HEARING a OF APPLICATION FOR ADJUSTMENT Oe OF CLAIM DISKICY NOTTI 1 T & HIS OF NOTTI IEVAM DISKICY NOTTI BGLINrs a 8 IEVAM he ak 22 19519 959 nk Sa Por 4 lad You are hereby notified that an application to adjust a claim for iit compensation compensation a copy of which is attached hereto has been filed with the Industrial Accident Commission of the State of California You are further notified that said rpplication has been set for hearing at PTE Room 206 1531 Webster Street Oakland August 15 1956 9:00 a.m. All Morning All issues and that at Baid time and place the Industrial Accident Commission of the State of California will proceed to hear and dispose of the said application in the manner prescribed by law in Note The parties are expected to submit all issues controversy for decision at this hearing therefore all necessary witnesses evidence documents medical reports payrolls and other essential proof must be available and ready for submission at the hearing Dated INDUSTRIAL ACCIDENT COMMISSION The undersigned certifies that as an employee of the Industrial Accident Commission she served the foregoing notice on the parties hereinafter mentioned at the time set oplosite oplosite their respective names by depositing a copy of said notice attached to a copy of the application therein mentioned in a acaled envelops in the United States mall on said day at San Francisco California with the postage thereon fully prepaid and addressed to the said perties at their their last known places of business or residence as follows to wit See attached sheet for Service FORK new 4-56 a an al ni i | ti ds s bh Hun. Sele i 6 NAMES OF PARTIES SERVED Bra. + @ am DATE OF SERVICE Smith Smith Swartout Bldg E. Mundet Cork Swartout Corp. 3000 Merrywood Merrywood Drive Financial Center 7101 Tonnelle Ave. Sacramento Calif Oakland Calir North Bergen N. J. 1958 22 JUN 22 Harry A. Dutton Ins 532 Natoma St. S.P. Calif Dutton Asbestos Co. 532 Natoma St. S.F. Calif Dutton Asbestos & Supply Co. 532 Natoma St. S.F. Calif Western Asbestos Co. 675 Townsend St. S.F. Call Bay City Asbestos Co. Ltd. 251 But 5th Ave. Oakland Calif . Oork Insulation Co. Inc. 730 - 5th Ave. N. Y. 4 Western Fibrous Olasa Prod Co. 739 Bryant St. S.F. Calif ; General Insulation & Rubber Corp. 1247 Main St. El Centro Calif 4 Armstrong Cork Co. Lancaster Pern Johns Manville Sales Corp. 22 East 40th St. N.Y. 3 C. C. Moore & Co. 450 Mission St. S.F. Calif 4 . J. T. Thorps & Son Inc. 1351 Ocean Avenue Emeryville Calif M. Carpenter 907 Front St. Sacramento Calif we j S. R. Dutton Company Natoms St. S.F. Calif ; Bay Cities Asbestos Co. 251-5th Ave. Oakland Calif Western Fiberglass Supply 739 Bryant St. S.P. Calif IThne sulatioMagnn esia 9.Py Calif 1 st Chicago Asbestos & Magnesia Materialo Co. Chicago Aleska Asbestos Seattle q Fairbanks Aleska Phillip Care Mfg Co Cincinnati Chio - Real Retd Retd Asbestos of Tacoma Anchorage Alaska Jgnar Chicago -Terre Haute Indiana ... - Retid Retid . Manville -Trenton New Jersey ... ... - Retel Kanufacturing Bristol Indiana Retel Insulation Haute Services . Kanufacturing Bristol Bristol ka Tuscon AriArizonazona Johns Manville Pittsburg Calif | Retel ReRetteel l Pillsbury Madison & Sutro 225 Bush St. S.P. Calif Aetna Insurance Co. 220 Montgomery St. S.F. Calif State Compensation Insurance Fund Personal Service Industrial Indemnity Exchange 155 Sansome St. S.P. Calif Industrial Indemnity Co. 350 Sensome St. S.F. S.F. Calif Pacific Indemnity Co. lit Sansome St. S.7 Calir Liberty Mutual Insurance Co. 216 Pine St. S.F. Calif Employers Mutual Liab Ins Co. of Wisconsin 114 Sansome St. S.F. Travelers Ins Co. 315 St. S.8 Calif Montgomery B^"andardAccident Ins Co. 417 Montgomery St. s.r. Calif Pacific Employers Ins Co. 505 Montgomery St. S.F. Calif Pacific Employers Ins Co. 3770 Piedmont Ave. Oakland Calif Keith Greede & Sedgwick 100 Bush St. 5.F. Calif Leonard we , Hanna & Brosy , 100 Bush St. S.F. Calif . . Calif