Document ga4d2rK3JnxyqY93ndXJoJLqG
FILE NAME Mundet Cork MCK
DATE 1962 DOC MCK142
DOCUMENT DESCRIPTION WC Claim of Staples John
STATE OF CALIFORNIA
INDUSTRIAL ACCIDENT COMMISSION
thebet thebet
MAY 28 28 HP HP
FILE SIGNED ONGINAL AND SEE
PLEASE PRINT OR TYPE NAMES
JOHN D. STAFLES
APPLICATION
COPIES
AND ADDRESSES
CASE
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TI ee
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62
NO 62 LB 19396
POLA POLA Phe
*
10634 CercB
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arepieatit California novenns
_JC hitier alifoCalir fornin a Cai lifoa rnia
wh
SEE LISTING ATTACHED --
INPLAYER INPLAYER
Social Security No. 49.2-12-3206 49.2-12-3206
EBLOID'S EBLOID'S caoeeie
UNKNOWN AT THIS TIME 9,243448 AURS 75
.
FARVURKKI KLKRESZ & #
.
John D. insulator Between and ep heat
Staples
WEARYET reenineinnny MADE WEARYET WEARYET on & frost
DERP^ MADNERP^ MANDERP^ MAN at rent or F^ ROY
24-25 24-25 alleges that while
Mate of bicTO
employed
Los Angeles County & .
1953
March_1_ March_1_ March_1_ March_1_ and FY B e BAT 20 LENIAI
Los vicinLEX_ See listing attached attached
traployment ALATS SPR^ ^ ^
CITY OK OR PLAST VKLIPE SKIFTE GELUE
he sustained injury arising out of ind in the course of the
California by
10 followe
to abraat brao toss dust fiberglass other
irritants dimane nga J^/kralsea ibha "cone Lungs and respiratory system
resulting in
1 Unknown
XE3FO WHLY Page or joaT NEVI DRIVKOU AND KABSFQVENT KABSFQVENT VESELEF
on FOSSU E WIK employer's daks or issuRAREI
tow
the FOSSU E AQ I^SWOJZTR^ KOP thjorte zfq5 #ALIAU
Tierra
was
TKLF4NI^ IGs^g^uten
insurance carrer
Since 1962 injury
March 1
dite of
PERJBG ^ igmena por^ De fua Kozur
4. Was compensatina paid NO
U oF aw
. Earnings at time of injury
.
Ma X.
**
1
needed Yea 4. Was medical treatment .
Yea
VIE DE nt
^ ^francks slagk31 ^ d^ ras
DAYS LAST NAPINAL SUSIRINK
...
BO have
~
WONINGE WONINGE #1ea
The
Who furnished treatment
GEECE JE
basis of pay wi
Buate PAY set^ka^ n^zZI
MY AIL
KATE OF LAS gabe BATA BATAR RBA TARDAZTIO T
Dr. George Fralick liability 1444390 application 7. This
determine fors is filed to
IDE IUM 20
1444390 444 X56 JU 46478 ODE NITEBRG WITH HJAL BUT
myas 1. Temporary disability b Permanent disabilesc # no be
e Litigation exprax VOS .
11 04
disabilesc
TPL ER DU
disabilesc Medical treatment.cs
TK en X
csteveae
STATE ANY FIDE M^'s101
yes d Afedical
yes PA Oo,
~~
nYWO^ A List 2401
OF 190883 190883 ^ ykjskvi^ k^Iykjskvi^ kINILED
the Workmen's WHEREFORE ander
II
is
requested
that
a
time
and
place
be
fired for
broting
and
that
;
proper ander
Workmen's ComCpenosamtiponensation CompensatCoimpeonsantion Laus California
an award be mm^^,d,e degranting such relief as may be
Dated of California : Wilmington California May 17 1962 LEFT
.
4
;
mare
Number of witnessa Extimsted time of trish
nw,
unknown
day
2
-
2
* * * * * * ***********
{ *********** ****** *********** ******
_SILVERNCWIL&LSIHERAMANMS 2
305
North
245 245 BERSOSIY BERSOSIY Avalon Boulevard
Wilmington 4-2 TE 5 4-259 95 5 0 California
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WITH Mana give en eH SA PE MEME Kee HE
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JOHN OT S DLES
Oct.
Oct. Nov. Dee
Baker Perkins 1000 Hoan v^ o
Seginaw Michigan
56 hours
3. T. Thorpe .
948 E 2nd St.
"
360
Los Angelos 12 Calif
CO
1954
n
Feb
Mar
.
",
17
Apr.
Moy
R
Juno
July
Aug
Sept.
C. F. Breun 1000 Premont St.
Alhambra Calif Cost Insulating 2684 2684 2684 In It
288
..
88 M
Sept. Oct.
Los Angeles 31 Cali^
J. 7. Thorpe
118
011 Field Constre 62
P.O. Mox 947
Bakersfield Calif
'
40 Hov
011 Field Constr
M
December J.t. Thorpa
F
360
"7
1955
lane Armstrong Contr
299 "
-
4bCO E. bendini
eb
Los_Angeles Los_Angeles Calif
PY
,
re J.T. Thorpe
1967 5
ril Armstrong Contr 6781 8 . y
-
ne
It
ly
1956
APR
May
June
July Aug. Sept.
Oct.
Nov. Doca Oct.
Fibor^les Engineering 1409 hr
5933 Telegraph Rd
Los Angolos
4
w"
22 Calif
BITOMY
" i !!
" !!td 467 ge 467
tye
" " "/
a
MMAYAYMAY
26 1902 26
1902
26
1
N
AND FII
...
Reace Insulation
4563 Valley Blvd. Los Angeles 32 Calif
ILFERE ... ILFERE ILFERE 85 ..
1957
Jan.
Feb
Mar
Apr.
H
June
July July July
JulyJuly
Aur.
Sept.
Sept.
Oct.
NOT NOT
NOT .
Dec.Dec.
Piberglas Engineering
ti M
Armstong Armstong Contr
F
Insulation Co.
x
1958
Reece Insulation
J. T. Thorpa
219
1149
R. T. Dinwiddie
71
486
...
Jane
Mare Apr.
July Aug. Sept.
Oct. Nov. Dooe
1959
R. T. Dinwiddio 8627 So. Atlantic
Southtt Grte Calif :
657 hrs
Fiberglas Engineering 366
Reece Insulation
& a
592
1960
Jane Mar.
April
Reece Insulation Kircher Asbestos
P.O. Box 4452
Phoenix Arizona
Los Angeles Cork
4190 2. Wachington Wachington
Los Angeles 23
33 40
172
June
Plant Asbestos 1540 W. 9th St.
1208
"
July
Long Beach Calif
Aug.
ny
Sept.
KE
Oct.
KE
Nov.
KE
Dece
KE
Jane
Fab Mare Apr. MAY
Juno
A45
Sopt Oct. Nov.
1961
Plant Asbestos
#t
cd
872
Mundet Cork Corp. 6116 Welker Ave.
102
Maywood Calif
Cul Stete comment
8623 Mettler St.
32
Los halen 5 Celif
Fiberrionngineerin Fiberrionngineerin
Plant Asbestos Co.
11
140
"
356
NG
ot
.
/
bea
'
Jan.
Feb. Feb.
Mar. Mar.
EOb M oh
41
Gy " m wal
} 281289196262281962 281962 281962 281962
. hin FR me ge
- met, -
U ENO
1962
U ENO ROFLIF
Plant Asbestos Company Company
Coast Insulating Armstrong Contr
172
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