Hazardous Substance Filing Notice, Fire Department, undated

NYC 9/11 Public Portal Document

Revised I ), ,, - .iportant: Read all instructions before completingform Reporting period: From January I to December j,. i @ Pave fi of 3 noes - N1±!'v' YORK Name A Hoebr1, •r i C Name,SHtgno4JH1r4 /s 14(ZA7[ Phone X 7 7Co, CITY Right-to-Know ` Street '7 v-icr L.~ T2gfl tL C EAJ" r r- - Mail Address _ SA u FACILITY '• ('ity N4«, Yo tz,,L, State J3 '1 Zip+4 /pO y zt - t 1 G_ INVENTORY 'Tale phone ~_---J Zt z 7n ~-7004 County •--- Name~~uA~z!~ f- CA'KP•3,c c. "1"itlel'fNPE,zr' N.h'<, c ;' _ DORM ( SIC Dun & brad. ~❑ ❑-.-,—❑ Da Phone t 2 78 3 r , 3 24-hr hon PII I•IER'f WO Code Number ~^ Name i ,ro G

l w O tc•io/ Use Only: IDtt Day Phone - c z ) 7 t~ 3 -r - ,- 2 3 24-hrphone; PII Date Received: Physical and Storage Codes and Locations Health (Non-Confidential) Chemical Description Hazards Inventory Storage Locations Cht'eL all that apphv f- CAS m ❑ 'trade ❑ Fire o Cheek box .3 O^ i i i M LCL (Autlt uH /1 Alf &-2Secret F .t Sudden Release Of Pressure ❑ Max Amount (code) f r 1(.- t= (oC if infomm,tion °.y. submitted 2a% P rACStuh NY~~2o~tDtl!?cofBJ❑ is identical Reactivity 0 '3 to last year Qq, CAOHtyrt oC~ n (l a Cct40) Avg. Amount (code) ZU Immediate (acute) 6 Check all that (r) rlv. Il . © Uclaycd(chmnio) `3 , I J Pure [tiJ'Mix [Solid [ ] Liquid [ ] Gas [ ] MIS No. of Daps Present CAS Trade ❑ C x ~~~ (-1-1 I I I I ❑ ❑ Secret Firo Sudden Release ❑ Max Amount (code) information ^ ❑ Of Pressure submitted ° Reactivity is identical v ❑ vg, morutt (code) to last year ❑ Immediate (acute) u Check all that apply: ii 1 ii I I Pure I I Mix I I Solid [ l Liquid [ ] Gas [ ] EhiS ❑ Dclayed(chttmic) No. ofDav~sPresent CAS (~'"~'~~~T Trade Check box I I ❑ ❑ Secret ❑ ❑ Fire ❑ if Sudden Release Ma.t' Amount (code) infom anion V ❑ Of Pressure submitted y . ❑ Reactivity is identical Y vg. Amount (code) to last year ZU ❑ Immediate (acute) - Check all that apply: [ ] Pure [ ] Mix [ ] Solicl [ ] Liquid [ ]Gas [ ] ENS ❑ Dclaycd(chmnic) No. ofDays Present liii❑ Ce'rti/lcation (Read acrd sign after completing alt sections) I ,:citify under penalty of law that I have personally examined and tun familiar with the OPTIONAL information submitted in pages one through _, and that based 1 have attached a on my inquiry of those individuals responsible for obtaining the information, I believe that the submitted information is true, accurate and complete. site plan Ol~u i4A(Li SDk, _ S; 1/t - ❑ Nat ie and official title of owner/operator OR owner/operator's authorized representative Signature Date signed 23

NYC-WTC 000169017