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Hazardous Materials Report Form, 7 World Trade Center

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New York State Department of State form requiring businesses to report hazardous materials presence for fire safety compliance.

NYC-WTC_000169137–000169143

Folder label: “7 World Trade Center Blue Prints Haz Mat Info Fire Reports Fire Prevention Records”

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NYC 9/11 Public Portal Document

ne NEB NEW YORK STATE DEPARTMENT OF STATE /0 :~° °~;• OFFICE OF FIRE PREVENTION AND CONTROL

2 ~ HAZARDOUS MATERIALS REPORT FORM (General Municipal Law, § 209•u)

The information entered 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* Salomon Smith Barney Same Firm Name Street Add. Only Seven World Trade Center N/A Bus. Add. Bldg. Name or No.

City, State, Zip - New York N Y 1 0048 N/A City, State, Zip

Tel. No. (212)783-7000 Policy Anniv. Date July 1 Name of Edward J Campbell ( Emergency Contact —~ ` / Bus.Tel. 212)783-6252 HomeTe P1~ Title of Person Complfting •It is suggested that a separate fdYm 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. Ali exemptions approved shall expire on the 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 000169139

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NYC-WTC_000169139Source: NYC Law Department, mirrored locally

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