Hazardous Substance Filing Notice, Fire Department, undated

NYC-WTC_000169014 Revised |i vy . portant: Read ail instructions before completing form Reporting period: From January | to December 91,2608 7 rage of & pages NEW YORK CITY Right-to-Know FACILITY INVENTORY FORM TIER TWO Name SAtoMoa) SHITH CARNE y Hocbw6s, INC. % Suect_ “7 Weetd TRADE CeyTE? City Dey Yote State WY Zipt4 (004F ~ (1G gs 43 Name Séiornoe Sure GAreté y Phone( 2/2 )733-7eed Mail Address SQ11&- TVelephone(_ 212 _) V82-"7e00 County SIC Dun & Brad. Code él2icte| Number For Official Use Only: DH | BUNDMETIPL NNO Y | Date Received: | (ol) (Tee) Cel Te Ts) | & ui = 148 Name Ep wartd J Caneséce Title Preve ety HMAvaGed Day Phone (2/2) 783-vy 23 24-hr phone (9! 7) 203-2797 Name Tito O. Hesjac Title AvsT. Pee feet MANAGE Day Phone (2 (2) 7837-23 24-hr phone (7 17) 760-46 7 Physical and Health Hazards Cheek all that apply Chemical Description Inventory Storage Codes and Locations (Non-Confidential) Storage Locations Uy S TTTTTLI CLIO i jo(sjauren No C Fire (s)eotmayD Pure {| Mix | | Solid [Liquid ( ] Gas | | EMIS Sudden Release Of Pressure [| Reaclivily [4 {inmediate (acuic) J Delayed(chmnic) FREOW ll: i900 ve METHAVE TRICHLOFLYoRO (2x¥-¢49-4) Check all that apply: 3 O12 Max Amount (code) Avg. Amount (code) RAMARS No. of Day's Present Check box if information submitted is identical to last year ce GD+tH Eloo(& . < we) (s}peouusys Jo (sjouren [Pure [ | Mix [ | Solid (/Liquid [ ] Gas { ] EHS Trade * COUT C0 Oo seve ] Fire Sudden Release Of Pressure [7 Reactivity Gi Immediate (acute) [4 Delayed(chronie) FREON 12: 100%, MeEtHANE Cheek all that apply: o| 1] Max Amount (code) Avg. Atnount (code) 3 lels| No. of Days Present Check box if information submnitted is identical to last year (x Eltl4 47th FLooe. S CTT Cho. Fire (s)peouusy7) Jo (sjauseny [ ) Pure (Mix | | Solid 4 Liquid [ ] Gas [ ] EHS Sudden Release OF Pressure (] Reactivity [4 Ininediate (acute) (] Delayed(chronic) HAWG WASH 10% Perecteun Svieowaré (61795- BC-3) jot PROPYLELE GeYycoL erie é (2b07-1v-+) Check all that apply, si = lax Amount (code) Se vg. Amount (code) {él sc] No. of Days Present Check box if information 4 submitted is identical to fast year Ee 47th Flos @ rs Certification (Read and sign after completing all sections) L eertily under penalty of kaw that | have personally examined and am familiar with the infonnation submitted in pages one through , and that based on my inquiry of those individuals responsible for obtaining the information, I believe that the submitted information is true, accurate and complete. _ 20k w Name and official title of uwner/operator OR owner/operator's authorized representative MARKSOU FreST Vice PRES\IEAT OPTIONAL | have attached a site plan Signature Date signed 4 23 NYC 9/11 Public Portal Document