Hazardous Substance Filing Notice, Fire Department, undated

NYC 9/11 Public Portal Document

Re 'iscit I !: ii cporlanl: Read (ill instructions before cutnpletirt>` loam 11coortine neriod: From January I to l)ecemhpr ,. ']hAQ ps... i , t' NFIV YORK Name S ALONotJ .SHtr µ GARu6'I Hot ( iJ s r i,r✓ C Name Name 5Awrtcu Srti t is& i2 y Phone ( aJ'! 3 '71 C CITY Right-to-Know Street --_ 7 kl02tn rRAo` CEurE(2 Mail Address S[~r_E FACILITY (.'ily Ve ~/oat~ State A) j Zip+4 jpp1j - It tib INVIiNIUR1' telephone( zt2 )783-7 o County NameEDca4R. v c'Anr',3Et.L_Title FORM SIC Dan & Bract• I 11:R'11VU Day Phone ZIL 7 24-hr phone; PII ('udi 6 ~❑ I / Number ❑0 / ~❑ / 6 3 ® I S' {- ------!-- Name r0 O. M~giAs TitleA=~r. , ry Aac..., /W • (J//ic•i~cl Case Only: IDii •' Date Received: - v Day Phone z t z) 7p3 -, .I- 2324-hr phond..............................--.......- Pil l

Physical and Storage Codes and Locations Health (Non-Confidential) Chemical Description Hazards Inventory Storage Locations Check all that apply U f- t AS r-- ~~~ m Q trade Q Firc MQ CC bx o E if

'y B105 P E(L E 2 S 5" t1 t C (UoQ Dec ~e SSudden dd R Release Max ni Aount (code) y 14 _ _N • _ L n R. (PL A A-' T7 ' infomtation o ❑ or Pressure u Is °% 6LuTAgAc.D£Ati bt;LlIi- a— submitted ❑ is Identical Reactivity Q Atg. Amount (code) to last year z I I Immediate (acute) U C'a,ek all that app(t': Dclaycd(chmnic)~~ ( I Pure [ Mix _i I Solid I 1i.iquid ( 1 Gas [ i EIIS _ No. of Days Present CAS _ — Trade if x 1 1 1 tH 1 ❑ ❑ Secret ❑ ❑ Fire

o n ZiOSPE2Sc 2S7 N1CQo21oC%DE. Sudden Release OfPiessure Max Amount (code) 1LEy N. F L o 0 PL 4 - information submitted H ZJ'✓o'fRIS(k11~t2oX`IMEtt+4l, Reactivity 1vIG1 is identical ' tJitR0hETctAuE~ttb-u-v~ ❑ A tg. A tnotrau(code) to last year i1 /,_to2rtALbcptic€.fro Immediate (acute) , Z Check aN that appit' [ ) Pure [ t.(' 4ix [ ( Solid [i4iquid [ ] Gas [ I EHS Dclayed(chmnic) 3 6 No. of Days Present EEJ © CAS Trade Check ❑ ❑ Secret ❑ Ftrc ❑0 o v I3LEo.CN sa t)1l)H Hy PO R TE Sudden Release Max Amount (code) N r y -7ri 1=L0 (z Y_ information Of Pressure i °% (7 6 1- 5L - submitted A V Reactivity is Identical SCD ___ __ ______ __ O-1 ____ Y `ltl vg. mount (code) to last year GU 131 a --73-Z, ❑ 1111I11e(ilillC (acute)

Check all that apply: Dclaycd(chmnic ) ( J Pure [v['Mix [ I Solid I4 Liquid [ ] Gas [ I EHS ❑ No. ofDuvs Present (.'rrlryication (Read and sign after completing all sections) I crnily under penalty ut• law that I have personally examined and tun OP-I tONAL familiar with the information submitted ill pages one tlu•ough __,and that Oil Illy inquiry of those individuals responsible for obtaining the information, I based 1 have attached a believe that the submitted information is true, accurate and complete. site plan -TQ Q_-_--_►jA2V—S0U FtP-S; ViCi: 12 ~S , bc{-~i ❑ Nai ie and official title of• owner/operatoi• OR owner/operator's authorized representative Signature Date signed

23

NYC-WTC 000169011