HomeMy WebLinkAbout00000FF
SUPPLEMENTAL INFORMATION
r
BUSINESS ADDRBSS 444114 + r LlW°°
2.
Person to cry., _ •ict in case .)f emergency z
i
Telephone namber ;
^-- ---
r
3.
Does the building its question JI?,ve el�
as
a. if No, are you zega esting that the electricity be
No
, -Yes
turned on?
ONO
4,
The building is sprirlklered?
0Yes
5.
Operations wil' ,produce dart/wood shavings, or oimilar
material?
13Yes
-No
6,
Operationswill involve the repair or replacemaent. of
Dyes
automobile parts?
�No
if yes:
�} Describe the components repaired or replaced.
(b) Does the opera;.ion involve the use of an open flame
tlXes
ONO
€ 7.
The business is d.. nking, dining cr assembly use that will
zPsult in an Occupant loan of more than 50 persono.
Oyes
B.
The followin-q best describes my ,operation;
office -
„anl
Sales
Warehouse
Manufacturing/Distribution (describe process and end
pro"?uct )
Medilt^al/Oental
dither.•, (describe)
(0562D) tl2/8/S6j
.:- „„ . , .: „F� � ...,�, � x�>,�a: .� ,gin-r� • „ .. ,�. �„ s� �
SUPPLEMENTAL INFORMATION
(Continued)
Does the OPQration involve any of the 'following materialc7 Mes
,QN o
C xes in irate quantities;
Material
quantity
. Flammable liquid-,
Class IA
Class I-E
Class _X-C
2. Combustible liquids
clas4 II
H Class III -A
i' 3, Combination flammable liquids
4. Flammable gases
S. Liquefied flan
Flammable fibers - loose
- r
M 7» Flammable fibers baled
• 8. Flammable soliCs
9. Unstablematerials'
10 Corrosive liquids
11. Oxidizinct materialcases
F 12. Oxidiztulmaterial liquids
13. Oxidizin, material - solids
i` 15: Nittomethane (unstable?�materi a i s)
16 Ammoniumnitrate
Y ..
17. Ammonium nitrate compound iti.xt:ure,:r
containing more than 60% niEr;jte
18. Highly toxic material and
i�OiSOnolls q�5
»' Smokelessowder
,...;
20. Black sporting powder
I hereby certify that the above informa»ion
best of my krawledge,
is "rue and correct to the
Ante
(0562O)(1218/86
y
'