NYC 9/11 Public Portal Document
Ilnwel-11 I i .... ..,,u•,,n,r• Pon,l ,tll hivIrm'lin„-t• Imfil,r en,nlntint, fnr•nt RenortinL neriod: From January I to December i 1. i »9 Page ( of . pages
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INVENTORY •I,elcpltotje Z i Z 7 83 -7000 County Name f.Auni2 l) -~ C,Vi' ELL Title fi t: c:;+;'
FORM SIC Dun & Rrad. Day Phone (2 (2 7 0 2-t-.i` a ? 24-hr phoned PI
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Day Phone Z 1 Z ) 76 3 - ,f 2 .7 24-hr phone PI I
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/ ~„ Official Use Orrlt': 1Dtt Date Received:
Physical and Storage Codes and Locations
Health (Non-Confidential)
Chemical Description Hazards Inventory Storage Locations
Check all that apptl-
CAS
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❑ Trade
❑ Fire
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Secret 1 4 Fig
1 1-Sudden Release MarAntamt (code) F z `( iL_'7 information
~ /J 0 JS )i A4 7s % It-rt-iiLEi i.Heo,2'D,~. , vl Of Pressure submitted
o is identical
y~, 11 PRJ f n,J t 7fi !3 '~o (
Eli Reactivity to tast year
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Immediate (acute)
Atg. Amount (cocleJ
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t""c) No. ofDa,;t• Present ~' r
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MIRY Amount (code) I cf ~1 ~ , ' information
.$mod >' y!+ 3 'Yo -Se L.1(0 uE 3 tYP 6 L 5'J la af Pressure submitted
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y Ry S! fJ Reactivity Q to last year
°J j7 , l 3 A 7 r 18 5 2y / IjnPAFh L+ Nt +7;. ,noun! (code)
y r Immediate (acute)
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Check all that apply:
No. of Dm's Present
[ ] Pure [ Mix [ ] Solid { 'Liquid [ ] Gas [ j EHS ❑i Delayed(chtnnic)
CAS
❑
Trade
❑ Secret ❑ ❑ Fire 10 / Check box
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Sudden Release Max Amount (c•ode) information
v ZOQ tQtt- sat.Ut3Le sp,rrcp ❑ OfPressurc submitted
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❑ Reactivity to last year
J ° /~~at, r4u~ ( -n- 2 .sS) vg, mount (code)
(~v ta• Innnediate (acute)
3 6 J ❑
Check all Thai apply: Dclaycd(clunnic) No. ojDl{t s Presera
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[ ] Pure [ c iix [ ] Solid [ ~iquid [ ] Gas [ ] EHS ( J
Certification (Read and .sign after completing all sections) OPTIONAL
I certify under penalty of law that I have personally examined and am familiar with the information submitted in pages one through , and that based I have attached a
on Illy inquiry of those individuals responsible for obtaining the information, I believe that the submitted information is true, accurate and complete. site plan
Ft2SI vtt✓ - - ❑
Nan e and official title of owner/operatot Olt owner/operator's authorized representative Signature Date signed
23
NYC-WTC 000166330
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