MSDS for DuPont Freon 12 Refrigerant, Oct 1996

NYC 9/11 Public Portal Document

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1 NEW YORK STATE DEPARTMENT OF STATE OFFICE OF FIRE PREVENTION AND CONTROL

HAZARDOUS MATERIALS REPORT FORM kJ- / (General Municipal Law, § 209 y) ’••tj’VtNT o'.

The information en'tered herein is essential to your local fire chief for the protection of your employees, the fire­ fighters and citizens in the immediate area, and to reduce damage to your property in the event of a fire or an emergency. Every fire insurance policyholder, engaged in commerce in this state, is required by law to report the presence of hazardous materials at their business address. Failure to file in accordance with the provisions of section 209-u of the General Municipal Law could result in a fine. A separate report is required annually for each business address.

WHEN COMPLETED, THIS FORM MUST BE SENT TO YOUR LOCAL FIRE DEPARTMENT.

Hazardous Materials Location* Saloinon Brothers Inc Same Firm Name street Add. Only ___ Seven World Trade Center N/A Bus. Add. Bldg. Name or No New York, New York 10048 N/A City, State, Zip ______________________________ City, State, Zip (212) 783-7000 July 1 Tei. No. Policy Anniv. Date Name of Jack Glass Emergency Contact_____________ ___________________ (212) 783-6252 Bus. Tel._____________ HomeTeli. PH

(Signature and Title of Person Completing Form)

*lt is suggested that a separate form be filled out for each building that contains hazardous materials.

EXEMPTIONS Requests for exemptions from this law must be made in writing, attached to this form, and filed annually with your local fire department not later than the anniversary date of your policy. Al! sxemptioris approved shall expire on th© next policy anniversary date. Exemptions denied shall require that the insured file a completed hazardous materials report form within 15 days of denial.

FOR FIRE DEPARTMENT USE ONLY

Exemptions: Approved Denied Additional Information Needed

(Date) (Signature of Fire Chief)

(Fire Department Name and Address) (Print Name of Fire Chief)

DOS-347 New York State Department of State, Office of Fire Prevention and Control

NYC-WTC_000166405