Hazardous Substance Filing Notice, Fire Department, undated

NYC 9/11 Public Portal Document

Revised I !, „ . .lportant: Read all insbvctions before completing-forin Reporting period: From January I to December i. r, 9 Pave i of naves Nr1v i'0P.K Name S(1cAKou s1/r1 6A2vcy µoLn,/u6f ' t IJ C NameSb40o,v H J7 , ro' At4Cr Phone z , 7~,; CITY ~— =-- Right-to-Know t; Street — 1 ly 0 D TR I'JE 4)T k Mail Address __ S -A n E — — FACILITY ' CityA)C_uu `/o State .LJ '— Zip+4 /00 4'$ - 1t 5 6 INVENTORY Telephone ZIz 783 1 aoo County Name E.11UA C6 .% CR~t E 1, L - Title t'l::'cr';r,' FORM S'/C Dun & Brad. ---- ------ ---- ----------- - Day Phone IZ 78 i 24-hr phone` PIt.- --.-.---.-.- TIER TWO Code 6 12 I / I Number 10H1 i6 3 ( )- =• Name j , r- o C Titled! _ __ y a Day Phone z ) - I z 78 9 f 4- 2? 24-hr plion . Plrl ----------- - hr Official Use Only : IDN Date Received: v .-.-.-.-.-.-.-.-.-._.-.-.-.-.-.-.-.-.-.-. Physical and Storage Codes and Locations Hea th (Nonage - Confidential)

Chemical Description Hazalyds Inventory ~ Storage Locations cheek oil that npptt• CAS fade Fire O Check box ❑ ❑ h' I if Secret ❑ F 2 ~( (1 0 SWEAi 71 o%a iler4it.Etc 4t1L0(erD~ I -Sudden Release Max Amount (code) — _ l 4 tea; ,_ ~_ infonttation L✓J Of Pressure submitted y i-Jq-z)f 11'/, PRdtA,7L(7y- 9B- 11 1.7 e Reactivity 0 j is identical In last Year

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Check (1/1 111[11 apple: Immediate (acute) Att, A!)10!!nt (t'O[le) 3 ►- - E /0 (-" 1

Dclayed(chmnic) Pure [t ix 1: ( Solid [✓ILiquid [ ] Gas [ ) LIIS ❑J L No. ofDays Present r l -- CAS Trade — — Chee k box [~ Secret ❑ lJ Fin / if ❑ ❑ Sudden Release Ali F4~-- ~~))~~ Max Amount (code) i 4 '~ 4 information &1 i' o o ' 3'Y s t c[ Ca uE (6 31Ye 6 2 ti ) Ea Of Pressure submitted e/ o" J 01,d_•taJC(_o_•_____ ~ , f~P~oPAJt(7Y4B'6~ Reactivity p ( is identical 1O last year 07 q J Ia f 3r„dtrCc_'7(-2 -5) ZO% ISnPARAFc,ut L 1g. Amount (code) Immediate (acute) z V jSY.DIZoCARltel .Ib~r£urIEY7f•Iz-Y6.41, o~wGl~l E to — check all that app!)': ( J Pure [ Mix [ ] Solid [ 'Liquid [ ] Gas [ ] EHS' (~ Delayed(chmnic) No of Days Present L_J CAS I— m ❑ Trade ❑ ❑ ( Check x Z I` f J`u y,, -rr£~Secret Firc (~ ( 14 F ' if Sudden Rcleasc Max Amount(code) I— 1 I k)Q O rI L f s ❑ Of Pressure information o submitted y (Sor_RORA y. c ( "I - 6 3 - o) G ( is identical ❑ Reactivity 1; lfnau - 4N~ ~71- -Z -.$) y vg. Amount (code) to last year v Immediate (acute) Z V t%s PA b tz (-7 Check all that apply: 3 G Delaycd(chronic) ] Pure [ c -1 tx [ ] Solid [ iquid [ ] Gas [ ] EHS No. of Days Present C. 'rtiffcation (Read and .cign after completing all sections) I certify under penalty of law that I have personally examined and am familiar with the information submitted in OPTIONAL pages one tlu-ough , and that based 1 have attached a on my inquiry of (hose individuals responsible for obtaining the infonnation, I believe that the submitted information is true, accurate and complete. site plan _ Q_H A o?J F t 2 S T V t c,(= P( L S[ D "' ,U i _ _ Nan e and official title of owner/operator' OR owner/operator's authorized representative Signature Date signed 23

NYC-WTC 000169007