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HomeMy WebLinkAboutCO2012-3572UNDER CONSTRUCTION CORRECTION LETTER PW OR LD NEEDED TD NO LETTER C/O CHECK LIST C/O PERMIT # P12 -`� �. ADDRESS: BUSINESS NAME: BUSINESS PROPERTY CHANGE NAME /OWNER ANEW TENANT /OCCUPANT V 1. 2. �3. 4. V 5. 6. 9. 10 1 1 12 i�13 �14 J 15 16 17 NEW CONST /ADDITION PERMIT # REMODEL /ALTERATION PERMIT ISSUE DATE FINAL DATE APPLICATION FORM COMPLETED ZONING MAP COPIED & WORKORDER FORM COMPLETED ZONING CHECKED & COMPLETED ON APPLICATION BUILDING INSPECTION SCHEDULED: DATE TIME FIRE DEPT. INSPECTION SCHEDULED: DATE TIME HEALTH INSPECTION: PUBLIC WORKS INSPECTION: LOT DRAINAGE INSPECTION: CORRECTION LETTER SENT: BUILDING INSPECTORS SIGN OFF FIRE DEPARTMENTS SIGN OFF HEALTH DEPARTMENT SIGN OFF PUBLIC WORKS SIGN OFF LOT DRAINAGE SIGN OFF LANDSCAPING SIGN OFF BUILDING OFFICIALS SIGNATURE C/O ISSUED * CONDITIONS TO BE TYPED ON C /O: YES / NO ():\FORMS \D SCOIN FOR MAT IO N \CKL IST 12/30/041 R- .11 \11 INSPECTOR DATE TIME E -MAIL DATE E -MAIL DATE DATE LETTER: YES / NO LETTER: YES / NO ELECTRIC RELEASE: COPY: MAILED: DATE OF ISSUANCE: _ i 0r l � PERMIT #: CERTIFICATE OF OCCUPANCY REQUEST FEE: $50.00 NO FEE REQUIRED IF CERTIFICATE OF OCCUPANCY ISASSOCIA TED WITH ANACTIVE CURRENT BUILDING PERMIT ADDRESS OF OCCUPANCY: 2101 ? +�- _ � . o _ _. _SI rn. # _._ LOT: R BLOCK: ' SUBDIVISION: IA"Sont A k.s _ HDovr-►arJ * ** *CERTIFICATE OF OCCUPANCY WILL NOT BE ISSUED WITHOUT LEGAL DESCRIPTION * * ** NAME OF BUSINESS: _�!� NEW OCCUPANT: YES _X — NO. NEW BUILDING /PROPERTY OWNER: YES — )<— NO NEW BUILDING: YES NO , _ NAME CHANGE: YES _ X NO NUMBER OF EMPLOYEES: _S _ .- -_ FREIGHT FORWARDING: YES .—NO X_ TYPE OF BUSINESS: - CtNj Erjl -NGE wL 6 it S. __ __ SQUARE FOOTAGE:. 3 2, I Z. (Example: Retail, Office, Warehouse) NAME OF TENANT: . 7N (�A__t tjmQPaasE s , LLC CURRENT MAILING ADDRESS: Z1ol 14Ati , LVuaStra (� CITY /STATE /ZIP: �•`T J _ _.� 1. _ _. _ PHONE NUMBER: PROPERTY OWNER: V��� S -_s LP MAILING ADDRESS: I65 VnL—)a,1yF_ CITY /STATE /ZIP: VJ"A-ttAt~-ti�LG - -_,, __T-X -7S I (OS- PHONE NUMBER: 66. S11 `Zap ♦ IS YOUR BUSINESS SUBJECT TO SALES TAX LAW? (if yes, provide copy of Sales Tax Certificate) YES _ A/ NO ♦ WILL THERE BE ALCOHOLIC BEVERAGE SALES? (if yes, provide copy of Alcoholic Beverage Permit) YES ✓ NO ♦ PERMITS ARE REQUIRED FOR SIGNS. WILL ANY SIGNS BE INSTALLED? YES _ ._ NO - ♦ WILL BUSINESS GENERATE ANY INDUSTRIAL WASTE DISCHARGE TO SEWER SYSTEM? YES _ NO ♦ WILL OUTSIDE REFUSE /RECYCLING /COMPACTING CONTAINERS BE NECESSARY? (if yes, screening is required) YES ✓ NO ♦ WILL THERE BE ANY OUTSIDE STORAGE, DISPLAY, USE OR DINING. YES _�/ NO ♦ WILL ANY ALTERATIONS BE MADE TO THE SITE OR BUILDING? YES NO ♦ IS BUILDING SPRINKLERED? YES _ _ NO _ _ ✓_ _ ♦ WILL BUSINESS STORE OR HANDLE HAZARDOUS MATERIALS OR LIQUIDS? (if yes, provide list of types & quantities, along with material safety data sheets) YES —V-"140 I HEREBY CERTIFY THAT THE FOREGOING IS CORRECT TO THE BEST OF MY KNOWLEDGE AND THE SAID OCCUPANCY IS IN CONFORMANCE WITH THE INFORMATION HEREIN SET FORTH. (If access to the building /space is not provided at the time of the scheduled inspection, a $42.0 spection fee will be charged) FOR QUESTIONS PLEASE CALL (817) 410 - 3165. 4 PRINT NAME: _ cv Aa Aoj ^ KCB Dtl q_ _ ____ _ - SIGNATURE: PHONE #: z�i -_.o - - EMAIL: , (OVER) Development Services Department The City of Grapevine P.O. Box 95104 * Grapevine, Texas 76099 (8 17) 410 -3165 Fax (817) 410 -3012 * www.grapevinetexas.gov 000RNMOoApplind- 3 122/2001 /11evks d:5/05, 5106, 2/07,4109 TEXAS SALES TAX Texas Sales Tax is charged and collected on sales within the State and City of Grapevine, Texas of "taxable items." Taxable items include both tangible personal property, specified services. If you are in a business that will be selling "taxable items" within the City of Grapevine, Texas you will be required to collect State and Local Sales Tax in the amount of 8.25 %. A "Seller or Retailer" means a person engaged in the business of making sales of "taxable items ", the receipts from which are included in the measure of sales or use tax. The term, "place of business" includes any location at which three or more orders are received by the "Seller or Retailer in a calendar year. If an order is received at the place of business of a retailer in Texas, but delivery or shipment is made from a location within the state other than the retailer's place of business. State and local sales tax is due and is allocated to the city where the order was received. I have read the above and I understand that I will be required to provide a copy of the Sales Tax Permit to the City of Grapevine, Texas if the circumstance applies to my business. Texas Sales Tax Number: Signature: ` Q TYPE OF CONSTRUCTION: ZONING DISTRICT: PERMITTED USE- BUILDING DEPARTMENT: ._ OFFICE USE OCCUPANCY: _Vo% DIVISION: CONDITIONAL USE: - ZONING APPROVAL: FIRE DEPARTMENT:_ ` LOT DRAINAGE INSPECTION: PUBLIC WORKS DEPARTMENT: HEALTH DEPARTMENT: LANDSCAPING APPROVAL: APPROVAL FOR ISSUANCE: 0:1F0R M\C /OAp p8a aU o n 3/22/200 URa is, d: 5106, 5106, 2/07,4/09 DATE: DATE:�� DATE: DATE: - ii- DATE: 1 DATE:.. _'..�..�.. DATE: 2120 -448 GU z mb GE 1G3Solo'- tLIZABF z N�a�P 1 A 352 N R��x ON iReW TR IbJa 1A if fax ,I SGNp°V H ��NGNepaN N PGE 1 {` 1 W 230A 11 P6kvwN 1 1 � 3 3p6� 1 IR p., / n R � R 1 R IR OP pPKN, K ,R ]IR 3R � 6P iP 2120 -440 c GU E n ! ! e PRyC p t b n v z n a GU q01 TR;n+u ,R la z i °RNs cE I e WILLIAM ° E 1 � G�,pDNG i icy p O A 40 PP 0 I � eg C7 PCD F tiGP Nei e po N c U�Gen�t M 311g5R F SARRA ' R -5:0 1 iP N 6PNK O°N SAN ! a R jNvp m m m j HCO ! b PO � a b ] • u n w �---z v TR,b �.y1 2 1 At ! r ry j iE 1 u x \a N � r � Alos QN►.4 1< a a n 1N�•GP� °�' t a 1]j • � t b � b y n l� cc va xe 1 I .`f—• �y�... -. _I { GP�Npp�. 3 • ! > ! e,nv • • m � t x ] • � � T i !� t_, N TR! „ a GU 20 16 1 11 u ]I x m a zs u b 0 u� e �poN pS�2'G Pp�M ti�3 I Al tSN� C N JpNN NN traBS 16169 z g1° p GP° yg�04R ON 1 PQ 2 aaE, 9 1 CC UN' q, 6 b GU z mb GE 1G3Solo'- tLIZABF z N�a�P 1 A 352 N R��x ON iReW TR IbJa 1A if fax ,I SGNp°V H ��NGNepaN N PGE 1 {` 1 W 230A 11 P6kvwN 1 1 � 3 3p6� 1 IR p., / n R � R 1 R IR OP pPKN, K ,R ]IR 3R � 6P iP 2120 -440 c GU E n ! ! e PRyC p t b n v z n a GU q01 TR;n+u ,R la z i °RNs cE I e WILLIAM ° E 1 � G�,pDNG i icy p O A 40 PP 0 I � eg C7 PCD F tiGP Nei e po N c U�Gen�t M 311g5R F SARRA ' R -5:0 1 iP N 6PNK O°N SAN ! a R jNvp m m m j HCO ! b PO � a b ] • u n w �---z v TR,b �.y1 2 1 At ! r ry j iE 1 u x \a N BR LS Diesel 2 810 2% MSOS# 402989M Version 1. Material Safety Data Sheet Effective Date 06/1612007 According to OSHA Hazard Communication Standard, 29 CFR 1910.1200 1. MATERIAL AND COMPANY IDENTIFICATION Material Name BR LS Diesel 2 BIO 2% Uses Fuel for on -road diesel - powered engines. Company Motiva Enterprises LLC P.O. Box 4540 Houston, TX 77210 -4540 United States MSDS Request 877 - 276 -7285 Emergency Telephone Number Spill Information 877- 242 -7400 Health Information 877 -504 -9351 2. COMPOSITION /INFORMATION ON INGREDIENTS Chemical Name CAS No. Concentration EnviroDiesel 8100 67762 -38-3 0.00- 2.00% Fuels, diesel, no.2 68476 -34 -6 98.00 - 100.00 % Dyes and markers can be used to indicate tax status and prevent fraud. Contains /may contain full range straight run middle distillate. Contains/may contain light catalytic cracked distillate. Containsimay contain hydrotreated middle distillate. Contains organic sulfur compounds. Contains Benzene, CAS # 71 -43 -2. 3. HAZARDS IDENTIFICATION Health Hazards Inhalation Slightly irritating to respiratory system. Breathing of high vapour concentrations may cause central nervous system (CNS) depression resulting in dizziness, light- headedness. headache and nausea, Skin Contact May cause moderate irritation to skin. Repeated exposure may cause skin dryness or cracking. 1/11 Print Date 06/26/2007 MSDS_US OCT S '270-1-- '' ell) .r Emergency Overview Appearance and Odour Clear, bright liquid. Hydrocarbon. Health Hazards Harmful: may cause lung damage if swallowed. Vapours may cause drowsiness and dizziness. A component or components of this material may cause cancer. This product contains benzene which may cause leukaemia (AML — acute myelogenous leukaemia). Safety Hazards Combustible liquid. Electrostatic charges may be generated during pumping. Electrostatic discharge may cause fire. Environmental Hazards Toxic to aquatic organisms, may cause long -term adverse effects in the aquatic environment. Health Hazards Inhalation Slightly irritating to respiratory system. Breathing of high vapour concentrations may cause central nervous system (CNS) depression resulting in dizziness, light- headedness. headache and nausea, Skin Contact May cause moderate irritation to skin. Repeated exposure may cause skin dryness or cracking. 1/11 Print Date 06/26/2007 MSDS_US OCT S '270-1-- '' ell) .r BR LS Diesel 2 BID 2% MSDStd 402989M Version 1. Material Safety Data Sheet Effective Date 06/1612007 According to OSHA Hazard Communication Standard, 29 CFR 1910.1200 Eye Contact May cause slight irritation to eyes. Ingestion Harmful: may cause lung damage if swallowed. Other Information A component or components of this material may cause cancer. Skin Contact This product contains benzene which may cause leukaemia (AML — acute myelogenous leukaemia). Signs and Symptoms If material enters lungs, signs and symptoms may include coughing, choking, wheezing, difficulty in breathing, chest congestion, shortness of breath, and/or fever. The onset of Eye Contact respiratory symptoms may be delayed for several hours after exposure. Ingestion Defatting dermatitis signs and symptoms may include a burning sensation and/or a dried /cracked appearance. Skin irritation signs and symptoms may include a burning sensation, redness, swelling, and/or blisters. Aggravated Medical Pre - existing medical conditions of the following organ(s) or Condition organ system(s) may be aggravated by exposure to this material: Skin. Environmental Hazards Toxic to aquatic organisms, may cause long -term adverse effects in the aquatic environment. Additional Information This product is intended for use in closed systems only. 4. FIRST AID MEASURES Inhalation Remove to fresh air. If rapid recovery does not occur, transport to nearest medical facility for additional treatment. Skin Contact Remove contaminated clothing. Immediately flush skin with large amounts of water for at least 15 minutes, and follow by washing with soap and water if available. If redness, swelling, pain and /or blisters occur, transport to the nearest medical facility for additional treatment. Eye Contact Flush eye with copious quantities of water. If persistent irritation occurs, obtain medical attention. Ingestion If swallowed, do not induce vomiting: transport to nearest medical facility for additional treatment. If vomiting occurs spontaneously, keep head below hips to prevent aspiration. If any of the following delayed signs and symptoms appear within the next 6 hours, transport to the nearest medical facility: fever greater than 101° F (37° C), shortness of breath, chest congestion or continued coughing or wheezing. Advice to Physician Treat symptomatically. Potential for chemical pneumonitis. Consider: gastric lavage with protected airway, administration of activated charcoal. Administration of carbon for medicinal use (carbo medicinalis) may reduce absorption from the digestive tract. 5. FIRE FIGHTING MEASURES Clear fire area of all non - emergency personnel. Flash point > 52 °C / 126 °F Explosion / Flammability 0.5 - 4.4 %(V) limits In air 2111 Print Date 06/26/2007 MSDS_US 1 BR LS Diesel 2 BIO 2% ( MSDS# 402989M Version 1. Material Safety Data Sheet Effective Date 06/16/2007 According to OSHA Hazard Communication Standard, 29 CFR 1910.1200 Auto ignition temperature : 260 °C 1 500 °F Specific Hazards Hazardous combustion products may include: A complex mixture of airborne solid and liquid particulates and gases (smoke). Carbon monoxide. Oxides of sulphur. Unidentified organic and inorganic compounds. Carbon monoxide may be evolved if incomplete combustion occurs. Will float and can be reignited on surface water. Flammable vapours may be present even at temperatures below the flash point. Extinguishing Media Foam, water spray or fog. Dry chemical powder, carbon dioxide, sand or earth may be used for small fires only. Unsuitable Extinguishing Do not use water in a jet. Media Protective Equipment for Wear full protective clothing and self- contained breathing Firefighters apparatus. Additional Advice Keep adjacent containers cool by spraying with water. 6. ACCIDENTAL RELEASE MEASURES Avoid contact with spilled or released material. For guidance on selection of personal protective equipment see Chapter 8 of this Material Safety Data Sheet. See Chapter 13 for information on disposal. Observe all relevant local and international regulations_ Evacuate the area of all non- essential personnel. Ventilate contaminated area thoroughly. Protective measures Do not breathe fumes, vapour. Do not operate electrical equipment. Shut off leaks, if possible without personal risks. Remove all possible sources of ignition in the surrounding area. Use appropriate containment (of product and fire fighting water) to avoid environmental contamination. Prevent from spreading or entering drains, ditches or rivers by using sand, earth, or other appropriate barriers. Attempt to disperse the vapour or to direct its flow to a safe location for example by using fog sprays. Take precautionary measures against static discharge. Ensure electrical continuity by bonding and grounding (earthing) all equipment. Clean Up Methods For small liquid spills (< 1 drum), transfer by mechanical means to a labelled, sealable container for product recovery or safe disposal. Allow residues to evaporate or soak up with an appropriate absorbent material and dispose of safely. Remove contaminated soil and dispose of safely. For large liquid spills (> 1 drum), transfer by mechanical means such as vacuum truck to a salvage tank for recovery or safe disposal. Do not flush away residues with water. Retain as contaminated waste. Allow residues to evaporate or soak up with an appropriate absorbent material and dispose of safely. Remove contaminated soil and dispose of safely. Shovel into a suitable clearly marked container for disposal or reclamation in accordance with local regulations. Additional Advice Notify authorities if any exposure to the general public or the environment occurs or is likely to occur. Local authorities should be advised if significant spillages cannot be contained. Maritime spillages should be dealt with using a Shipboard Oil Pollution Emergency Plan (SOPEP), as required by MARPOL 3111 Print Date 06/26/2007 MSDS_US SR LS Diesel 2 BID 2% MSDS# 402969M Version 1. Material Safety Data Sheet Effective Date 06116/2007 According to OSHA Hazard Communication Standard, 29 CFR 1910.1200 Annex 1 Regulation 26. U.S. regulations may require reporting releases of this material to the environment which exceed the reportable quantity (refer to Chapter 15) to the National Response Centre at (800) 424 -8802. Under Section 311 of the Clean Water Act (CWA) this material is considered an oil. As such, spills into surface waters must be reported to the National Response Centre at (800) 424 -8802. This material is covered by EPA's Comprehensive Environmental Response, Compensation and Liability Act (CERCLA) Petroleum Exclusion. Therefore, releases to the environment may not be reportable under CERCLA. 7. HANDLING AND STORAGE General Precautions Avoid breathing vapours or contact with material. Only use in well ventilated areas. Wash thoroughly after handling. For guidance on selection of personal protective equipment see Chapter 8 of this Material Safety Data Sheet_ Use the information in this data sheet as input to a risk assessment of local circumstances to help determine appropriate controls for safe handling, storage and disposal of this material. Air-dry contaminated clothing in a well- ventilated area before laundering. Properly dispose of any contaminated rags or cleaning materials in order to prevent fires. Prevent spillages. Use local exhaust ventilation if there is risk of inhalation of vapours, mists or aerosols. Never siphon by mouth. Contaminated leather articles including shoes cannot be decontaminated and should be destroyed to prevent reuse. For comprehensive advice on handling, product transfer, storage and tank cleaning refer to the product supplier_ Handling Avoid inhaling vapour and/or mists. Avoid prolonged or repeated contact with skin. When using do not eat or drink. Extinguish any naked flames. Do not smoke. Remove ignition sources. Avoid sparks. Earth all equipment. Electrostatic charges may be generated during pumping. Electrostatic discharge may cause fire. Not expected to be a health hazard when used under normal conditions. Storage Drum and small container storage: Drums should be stacked to a maximum of 3 high. Use property labelled and closeable containers. Tank storage: Tanks must be specifically designed for use with this product. Bulk storage tanks should be diked (bunded). Locate tanks away from heat and other sources of ignition. Vapours from tanks should not be released to atmosphere. Breathing tosses during storage should be controlled by a suitable vapour treatment system. The vapour is heavier than air. Beware of accumulation in pits and confined spaces. Product Transfer Avoid splash filling. Wait 2 minutes after tank filling (for tanks such as those on road tanker vehicles) before opening hatches or manholes. Wait 30 minutes after tank filling (for large storage tanks) before opening hatches or manholes. Keep containers closed when not in use. Do not use compressed air 4/11 Print Date 06/26/2007 MSDS_US l BR LS Diesel 2 BIO 2% MSDS# 402989M Version 1. Material Safety Data Sheet Effective Date 06116/2007 According to OSHA Hazard Communication Standard, 29 CFR 1910.1200 for filling, discharging or handling. Contamination resulting from product transfer may give rise to light hydrocarbon vapour in the headspace of tanks that have previously contained gasoline. This vapour may explode if there is a source of ignition. Partly filled containers present a greater hazard than those that are full, therefore handling, transfer and sampling activities need special care. Recommended Materials For containers, or container linings use mild steel, stainless steel. Aluminium may also be used for applications where it does not present an unnecessary fire hazard. Examples of suitable materials are: high density polyethylene (HDPE) and Viton (FKM), which have been specifically tested for compatibility with this product. For container linings, use amine - adduct cured epoxy paint. For seals and gaskets use: graphite, PTFE, Viton A, Viton B. Unsuitable Materials Some synthetic materials may be unsuitable for containers or container linings depending on the material specification and intended use. Examples of materials to avoid are: natural rubber (NR), nitrile rubber (NBR), ethylene propylene rubber (EPDM), polymethyl methacrylate (PMMA), polystyrene, polyvinyl chloride (PVC), polyisobutylene. However, some may be suitable for glove materials. Container Advice Containers, even those that have been emptied, can contain explosive vapours. Do not cut, drill, grind, weld or perform similar operations on or near containers. Additional Information : Ensure that all local regulations regarding handling and storage facilities are followed. 8. EXPOSURE CONTROLS /PERSONAL PROTECTION Occupational Exposure Limits Material Source Type ppm m !m3 Notation Fuels, diesel, no.2 ACGIH TWA(Vapor and aerosol. 100 mg 1m3 as total hydrocarbons Fuels, diesel, no.2 ACGIH SKIN_DES(V apor and aerosol. ) Can be absorbed through the skin.as total h drocarbons Benzene ACGIH TWA Benzene ACGIH STEL 2.5 ppm Benzene ACGIH SKIN-DES Can be absorbed through the skin. Benzene OSHA REF Benzene OSHA TWA 1 ppm Benzene OSHA ISTEL 5 ppm Benzene OSHA III OSHA _ACT 10.5 ppm Benzene OSHA Z1A TWA 11 Ppm Benzene OSHA Z1A STEL 15 m Additional Information In the absence of a national exposure limit, the American Conference of Governmental Industrial Hygienists (ACGIH) Print Date 06/2612007 5/11 MSDS_US BR LS Diesel 2 BIO 2% MSDS# 402989M Version 1. Material Safety Data Sheet Effective Date 06/16/2007 According to OSHA Hazard Communication Standard, 29 CFR 1910.1200 recommends the following values for Diesel Fuel: TWA - 100 mg/m3 Critical effects based on Skin and Irritation. Skin notation means that significant exposure can also occur by absorption of liquid through the skin and of vapour through the eyes or mucous membranes. Shell has adopted as Interim Standards the OSHA Z1A values that were established in 1989 and later rescinded. Exposure Controls The level of protection and types of controls necessary will vary depending upon potential exposure conditions. Select controls based on a risk assessment of local circumstances. Appropriate measures include: Use sealed systems as far as possible. Adequate ventilation to control airborne concentrations below the exposure guidelines /limits. Local exhaust ventilation is recommended. Eye washes and showers for emergency use. Personal Protective Personal protective equipment (PPE) should meet Equipment recommended national standards. Check with PPE suppliers. Respiratory Protection If engineering controls do not maintain airborne concentrations to a level which is adequate to protect worker health, select respiratory protection equipment suitable for the specific conditions of use and meeting relevant legislation_ Check with respiratory protective equipment suppliers. Where air - filtering respirators are unsuitable (e.g., airborne concentrations are high, risk of oxygen deficiency, confined space) use appropriate positive pressure breathing apparatus. Where air - filtering respirators are suitable, select an appropriate combination of mask and filter. All respiratory protection equipment and use must be in accordance with local regulations. Respirator selection, use and maintenance should be in accordance with the requirements of the OSHA Respiratory Protection Standard, 29 CFR 1910.134. Hand Protection Personal hygiene is a key element of effective hand care. Gloves must only be worn on dean hands. After using gloves, hands should be washed and dried thoroughly. Application of a non - perfumed moisturizer is recommended. Suitability and durability of a glove is dependent on usage, e.g. frequency and duration of contact, chemical resistance of glove material, glove thickness, dexterity. Always seek advice from glove suppliers. Contaminated gloves should be replaced. Eye Protection Chemical splash goggles (chemical monogoggles). Protective Clothing Chemical resistant glovesigauntlets. boots, and apron (where risk of splashing). 9. PHYSICAL AND CHEMICAL PROPERTIES Appearance Clear, bright liquid. Odour Hydrocarbon. Flash point > 52 °C / 126 °F Explosion / Flammability 0.5 - 4.4 %(V) limits in air Id 6/11 Print Dale 06/26/2007 MSDS_US N f, BR LS Diesel 2 BIO 2% MSDS# 402989M Version 1. Material Safety Data Sheet Effective Date 06/16/2007 According to OSHA Hazard Communication Standard, 29 CFR 1910.1200 Auto - ignition temperature 260 °C / 500 °F Specific gravity 0.85 10. STABILITY AND REACTIVITY Stability Stable under normal conditions of use. Conditions to Avoid Avoid heat, sparks, open flames and other ignition sources. Materials to Avoid Strong oxidising agents. Hazardous Decomposition : Hazardous decomposition products are not expected to form Products during normal storage. Acute Dermal Toxicity Thermal decomposition is highly dependent on conditions. A Acute Inhalation Toxicity complex mixture of airborne solids, liquids and gases, including NTP: Known carcinogen. carbon monoxide, carbon dioxide and other organic compounds will be evolved when this material undergoes combustion or thermal or oxidative degradation. 11. TOXICOLOGICAL INFORMATION Basis for Assessment Information given is based on product data, a knowledge of the I Carcinogenicity Classification components and the toxicology of similar products. Acute Oral Toxicity Low toxicity: LD50 >2000 mg /kg , Rat Distillates (petroleum), light catalytic cracked Aspiration into the lungs when swallowed or vomited may IARC 2A: Probable carcinogen. cause chemical pneumonitis which can be fatal. Acute Dermal Toxicity Low toxicity: LD50 >2000 mg /kg , Rabbit Acute Inhalation Toxicity Low toxicity: LC50 >20 mg /I 11.00 h, Rat NTP: Known carcinogen. High concentrations may cause central nervous system depression resulting in headaches, dizziness and nausea; continued inhalation may result in unconsciousness and /or death. Skin Irritation May cause moderate skin irritation (but insufficient to classify). Prolonged/repeated contact may cause defatting of the skin which can lead to dermatitis. Eye Irritation Slightly irritating. Respiratory Irritation Slightly irritating. Sensitisation Not a skin sensitiser. Repeated Dose Toxicity Kidney: caused kidney effects in male rats which are not considered relevant to humans Mutagenicity Mutagenic; positive in in -vivo and in -vitro assays. Carcinogenicity Repeated skin contact has resulted in irritation and skin cancer in animals. Known human carcinogen. (Benzene) May cause leukaemia (AML - acute myelogenous leukaemia). (Benzene) Material I I Carcinogenicity Classification Fuels, diesel, no.2 ACGIH Group A3: Confirmed animal carcinogen with unknown relevance to humans. Distillates (petroleum), light catalytic cracked IARC 2A: Probable carcinogen. Benzene ACGIH Group Al: Confirmed human carcinogen. Benzene NTP: Known carcinogen. Benzene IARC 1: Human carcinogen. Print Date 06/26/2007 7/11 MSDS_US BR LS Diesel 2 BID 2% MSDS# 402989M Version 1. Material Safety Data Sheet Effective Date 08116/2007 According to OSHA Hazard Communication Standard. 29 CFR 1910.1200 Benzene OSHASP: Cancer hazard. Reproductive and Not expected to be a developmental toxicant, Developmental Toxicity 12. ECOLOGICAL INFORMATION Information given is based on a knowledge of the components and the ecotoxicology of similar products. Fuels are typically made from blending several refinery streams. Ecotoxicological studies have been carried out on a variety of hydrocarbon blends and streams but not those containing additives. Acute Toxicity Toxic: WEUIL501 -10 mg/I (to aquatic organisms) (LUEL50 expressed as the nominal amount of product required to prepare aqueous test extract). Mobility Floats on water. Partly evaporates from water or soil surfaces, but a significant proportion will remain after one day. If it enters soil, it will adsorb to soil particles and will not be mobile. Large volumes may penetrate soil and could contaminate groundwater. Contains volatile constituents. Persistenceldegradability Persists under anaerobic conditions. Major constituents are inherently biodegradable. The volatile constituents will oxidize rapidly by photochemical reactions in air. Bioaccumulation Contains constituents with the potential to bioaccumulate. Other Adverse Effects Films formed on water may affect oxygen transfer and damage organisms. 13. DISPOSAL CONSIDERATIONS Material Disposal Recover or recycle if possible. It is the responsibility of the waste generator to determine the toxicity and physical properties of the material generated to determine the proper waste classification and disposal methods in compliance with applicable regulations. Do not dispose into the environment, in drains or in water courses. Do not dispose of tank water bottoms by allowing them to drain into the ground. This will result in soil and groundwater contamination. Waste arising from a spillage or tank cleaning should be disposed of in accordance with prevailing regulations, preferably to a recognised collector or contractor. The competence of the collector or contractor should be established beforehand. Container Disposal Send to drum recoverer or metal reclaimer. Drain container thoroughly. After draining, vent in a safe place away from sparks and fire. Residues may cause an explosion hazard if heated above the flash point- Do not puncture, cut or weld uncleaned drums. Do not pollute the soil, water or environment with the waste container. Comply with any local recovery or waste disposal regulations. Local Legislation Disposal should be in accordance with applicable regional, national, and local laws and regulations. Local regulations may be more stringent than regional or national requirements and 8/11 Print Date 06/26/2007 MSDS_US l SR LS Diesel 2 BIO 2% MSDS# 402989M Version 1. Material Safety Data Sheet Effective Date 06/16/2007 According to OSHA Hazard Communication Standard, 29 CFR 1910.1200 must be complied with. 14. TRANSPORT INFORMATION uS Department of Transportation Classification (49CFR) Identification number NA 1993 Proper shipping name Diesel Fuel Class / Division Combustible liquid Packing group III Emergency Response Guide 128 No. Additional Information Oil: This product is an oil under 49CFR (DOT) Part 130. If shipped by rail or highway in a tank with a capacity of 3500 gallons or more, it is subject to these requirements. Mixtures or solutions containing 10% or more of this product may also be subject to this rule. IMDG Identification number Proper shipping name Class / Division Packing group Marine pollutant UN 1202 DIESEL FUEL 3 III No IATA (Country variations may apply) Identification number UN 1202 Proper shipping name Diesel fuel Class / Division 3 Packing group III 15. REGULATORY INFORMATION The regulatory information is not intended to be comprehensive. Other regulations may apply to this material. Federal Regulatory Status Comprehensive Environmental Release, Compensation & Liability Act (CERCLA) BR LS Diesel 2 BIO 2% () Benzene (71 -43 -2) Reportable quantity: 154 Ibs Reportable quantity: 10 Ibs Shell classifies this material as an "oil' under the CERCLA Petroleum Exclusion, therefore releases to the environment are not reportable under CERCLA. Clean Water Act (CWA) Section 311 Print Date 06/26/2007 9/11 MSDS_US SR LS Diesel 2 BIO 2% MSDSti 402989M Version 1. Material Safety Data Sheet Effective Date 06/16/2007 According to OSHA Hazard Communication Standard, 29 CFR 1910.1200 Benzene (71 -43-2) Reportable quantity: 10 Ibs Under Section 311 of the Clean Water Act (CWA) this material is considered an oil. As such, spills into surface waters must be reported to the National Response Centre at (800) 424 -8802. SARA Hazard Categories (3111312) Immediate (Acute) Health Hazard. Delayed (Chronic) Health Hazard. Fire Hazard. SARA Toxic Release Inventory (TRI) (313) Benzene (71 -43-2) 0.65% State Regulatory Status California Safe Drinking Water and Toxic Enforcement Act (Proposition 65) This product contains a chemical known to the State of California to cause cancer. Known to the State of California to cause birth defects or other reproductive harm_ New Jersey Right -To -Know Chemical List Benzene (71 -43-2) 0.65% Listed. ) Pennsylvannia Right -To -Know Chemical List Fuels, diesel, no.2 (68476.34 -6) 100.00% Listed. Benzene (71 -43 -2) 0.65% Special hazard. Environmental hazard. Listed. 16. OTHER INFORMATION Additional Information This document contains important information to ensure the safe storage, handling and use of this product. The information in this document should be brought to the attention of the person in your organisation responsible for advising on safety matters. NFPA Rating (Health, 2, 2, 0 Fire, Reactivity) MSDS Version Number 1. MSDS Effective Date 06/16/2007 MSDS Revisions A vertical bar (q in the left margin indicates an amendment from the previous version. MSDS Regulation The content and format of this MSDS is in accordance with the OSHA Hazard Communication Standard, 29 CFR 1910.1200. 10/11 Print Dale 06/2612007 MSDS US BR LS Diesel 2 BIO 2% �• MSDS# 402989M Version 1. Material Safety Data Sheet Effective Date 06/16/2007 According to OSHA Hazard Communication Standard, 29 CFR 1910.1200 MSDS Distribution : The information in this document should be made available to all who may handle the product. Disclaimer The information contained herein is based on our current knowledge of the underlying data and is intended to describe the product for the purpose of health, safety and environmental requirements only. No warranty or guarantee is expressed or implied regarding the accuracy of these data or the results to be obtained from the use of the product. 1 11111 Print Date 06/26/2007 MSDS_US BR Conventional Gasoline with EtOH MSDS# 401730M Version 6.0 Effective Date 09/09/2011 Material Safety Data Sheet According to OSHA Hazard Communication Standard, 29 CFR 1910.1200 1. MATERIAL AND COMPANY IDENTIFICATION Material Name BR Conventional Gasoline with EtOH Uses Fuel for spark ignition engines designed to run on unleaded fuel. Manufacturer /Supplier Motiva Enterprises LLC PO BOX 4540 Houston, TX 77210 -4540 USA MSDS Request 877 - 276 -7285 Emergency Telephone Number Spill Information 877- 242 -7400 Health Information 877- 5049351 2. COMPOSITION /INFORMATION ON INGREDIENTS Chemical Identity CAS No. Concentration Gasoline 90.00 - 100.00 % Ethanol 64 -17 -5 0.00- 10.00 % Contains Alkanes, Cycloalkanes, Alkenes and Aromatic Hydrocarbons, Mixture. Contains 1,2,4 Tri- methyl - benzene, CAS# 95 -63-6. Contains Styrene, CAS # 100 -42 -5. Contains Benzene, CAS # 71 -43 -2. Contains Toluene, CAS # 108 -88-3. Contains Ethylbenzene, CAS # 100-41 -4. Contains n- Hexane, CAS # 110 -543. Contains Xylene (Mixed Isomers), CAS # 1330 -20-7. Contains Naphthalene, CAS # 91 -20-3. Contains Cyclohexane, CAS# 110 -82 -7. 3. HAZARDS IDENTIFICATION Emergency Overview Appearance and Odour Bronze. Clear, bright liquid. Hydrocarbon. Health Hazards Harmful: may cause lung damage if swallowed. Irritating to skin. Vapours may cause drowsiness and dizziness. A component or components of this material may cause cancer. This product contains benzene which may cause leukaemia (AML - acute myelogenous leukaemia). May cause MDS (Myelodysplastic Syndrome). Safety Hazards Extremely flammable. The vapour is heavier than air, spreads along the ground and distant ignition is possible. Electrostatic charges may be generated during handling. Electrostatic discharge may cause fire. Environmental Hazards Toxic to aquatic organisms, may cause long -term adverse effects in the aquatic environment. 1/17 Print Date 09/10/2011 MSDS_US BR Conventional Gasoline with RON MSDS# 401730M ` Version 6.0 Effective Date 09/09/2011 Material Safety Data Sheet According to OSHA Hazard Communication Standard. 29 CFR 1910.1200 1. MATERIAL AND COMPANY IDENTIFICATION Material Name BR Conventional Gasoline with EtOH Uses Fuel for spark ignition engines designed to run on unleaded fuel. Manufacturer /Supplier Motiva Enterprises LLC PO BOX 4540 Houston, TX 77210-4540 USA MSDS Request 877 -276 -7285 Emergency Telephone Number This product contains benzene which may cause leukaemia Spill Information 877- 242 -7400 Health Information 877- 504 -9351 2. COMPOSITIONJINFORMATION ON INGREDIENTS Chemical Identity CAS No. Concentration Gasoline 90.00 - 100.00 % Ethanol 64 -17 -5 0.00- 10.00 % Contains Alkenes, Cycloalkanes, Alkenes and Aromatic Hydrocarbons, Mixture. Contains 1,2,4 Tri- methyl- benzene, CAS# 95 -63-6. Contains Styrene, CAS # 100 -42 -5. Contains Benzene, CAS # 71 -43-2. Contains Toluene, CAS # 108$8 -3. Contains Ethylbenzene, CAS # 100 -41-4. Contains n- Hexane, CAS # 110 -543. Contains Xylene (Mixed Isomers), CAS # 1330 -20-7. Contains Naphthalene, CAS # 91 -20-3. Contains Cyclohexane, CAS# 110 -82 -7. 3. HAZARDS IDENTIFICATION Print Date 09/10/2011 ®�! 2012 1/17 MSDS_US Emergency Overview Appearance and Odour Bronze. Clear, bright liquid. Hydrocarbon. Health Hazards Harmful: may cause lung damage if swallowed. Irritating to skin. Vapours may cause drowsiness and dizziness. A component or components of this material may cause cancer. This product contains benzene which may cause leukaemia (AML - acute myelogenous leukaemia). May cause MDS (Myelodysplastic Syndrome). Safety Hazards Extremely flammable. The vapour is heavier than air, spreads along the ground and distant ignition is possible. Electrostatic charges may be generated during handling. Electrostatic discharge may cause fire. Environmental Hazards Toxic to aquatic organisms, may cause long -term adverse effects in the aquatic environment. Print Date 09/10/2011 ®�! 2012 1/17 MSDS_US SR Conventional Gasoline with EtOH MSDS# 401730M Version 6.0 Effective Date 09109/2011 Material Safe Data Sheet According to OSHA Hazard Communication Standard, 29 CFR Safety 1910.1200 Health Hazards Inhalation Vapours may cause drowsiness and dizziness. Slightly irritating to respiratory system. Skin Contact Irritating to skin. Eye Contact Moderately irritating to eyes. Ingestion Harmful: may cause lung damage if swallowed. Other Information Possibility of organ or organ system damage from prolonged exposure; see Chapter 11 for details. Target organ(s): Blood- forming organs. Peripheral nervous system. May cause heritable genetic damage. Possible risk of harm to the unborn child. A component or components of this material may cause cancer. This product contains benzene which may cause leukaemia (AML - acute myelogenous leukaemia). May cause MDS (Myelodysplastic Syndrome). Signs and Symptoms Skin irritation signs and symptoms may include a burning sensation, redness, swelling, and /or blisters. If material enters lungs, signs and symptoms may include coughing, choking, wheezing, difficulty in breathing, chest congestion, shortness of breath, and /or fever. The onset of respiratory symptoms may be delayed for several hours after exposure. Breathing of high vapour concentrations may cause central nervous system (CNS) depression resulting in dizziness, light - headedness, headache, nausea and loss of coordination. Continued inhalation may result in unconsciousness and death. Damage to blood- forming organs may be evidenced by: a) fatigue and anemia (RBC), b) decreased resistance to infection, and /or excessive bruising and bleeding (platelet effect). Peripheral nerve damage may be evidenced by impairment of motor function (incoordination, unsteady walk, or muscle weakness in the extremities, and /or loss of sensation in the awns and legs). Eye irritation signs and symptoms may include a burning sensation and a temporary redness of the eye. Auditory system effects may include temporary hearing loss and /or ringing in the ears. Aggravated Medical Pre - existing medical conditions of the following organ(s) or Conditions organ system(s) may be aggravated by exposure to this material: Blood- forming organs. Peripheral nervous system. Skin. Environmental Hazards Toxic to aquatic organisms. May cause long -term adverse effects in the environment. Unlike other gasoline components, ethanol is miscible with water. Additional Information This product is intended for use in closed systems only. 4. FIRST AID MEASURES Inhalation Remove to fresh air. If rapid recovery does not occur, transport to nearest medical facility for additional treatment. Skin Contact Remove contaminated clothing. Immediately flush skin with large amounts of water for at least 15 minutes, and fallow by washing with soap and water if available. If redness, swelling, 2/17 Print Date 09/10/2011 MSDS US SR Conventional Gasoline with EtOH MSDS# 401730M Version 6.0 Effective Date 09/09/2011 Material Safe Data Sheet According to OSHA Hazard Communication Standard, 29 CFR Safety 1910.1200 pain and/or blisters occur, transport to the nearest medical facility for additional treatment. When using high pressure equipment, injection of product under the skin can occur. If high pressure injuries occur, the casualty should be sent immediately to a hospital. Do not wait for symptoms to develop. Eye Contact Flush eyes with water while holding eyelids open. Rest eyes for 30 minutes. If redness, burning, blurred vision, or swelling persist transport to the nearest medical facility for additional treatment. Ingestion If swallowed, do not induce vomiting: transport to nearest medical facility for additional treatment. If vomiting occurs spontaneously, keep head below hips to prevent aspiration. If any of the following delayed signs and symptoms appear within the next 6 hours, transport to the nearest medical facility: fever greater than 101 ° F (38.3 °C), shortness of breath, chest congestion or continued coughing or wheezing. Advice to Physician Treat symptomatically. Persons on disulfiram (Antabuse®) therapy should be aware that the ethyl alcohol in this product is hazardous to them just as is alcohol from any source. Disulfiram reactions (vomiting, headache and even collapse) may follow ingestion of small amounts of alcohol and have also been described from skin contact. 5. FIRE FIGHTING MEASURES Clear fire area of all non - emergency personnel. Flash point -40 °C / -40 °F (ASTM D -93 / PMCC) Upper I lower 1.3 - 7.6 %(V) Flammability or Explosion limits Auto ignition temperature > 250 °C / 482 °F Specific Hazards Hazardous combustion products may include: A complex mixture of airborne solid and liquid particulates and gases (smoke). Carbon monoxide. Unidentified organic and inorganic compounds. The vapour is heavier than air, spreads along the ground and distant ignition is possible. Will float and can be reignited on surface water. Suitable Extinguishing Foam, water spray or fog. Dry chemical powder, carbon Media dioxide, sand or earth may be used for small fires only. Unsuitable Extinguishing Do not use direct water jets on the burning product as they Media could cause a steam explosion and spread of the fire. Simultaneous use of foam and water on the same surface is to be avoided as water destroys the foam. Protective Equipment for Proper protective equipment including breathing apparatus Firefighters must be wom when approaching a fire in a confined space. Additional Advice Keep adjacent containers cool by spraying with water. If possible remove containers from the danger zone. If the fire cannot be extinguished the only course of action is to evacuate immediately. Contain residual material at affected sites to prevent material from entering drains (sewers), ditches, and waterways, 3/17 Print Date 09/10/2011 MSDS_US BR Conventional Gasoline with EtOH MSDS# 401730M Version 6.0 1 Effective Date 09/09/2011 Material Safety Data Sheet According to OSHA Hazard Communication Standard, 29 CFR Y 1910.1200 6. ACCIDENTAL RELEASE MEASURES Avoid contact with spilled or released material. Immediately remove all contaminated clothing. For guidance on selection of personal protective equipment see Chapter 8 of this Material Safety Data Sheet. For guidance on disposal of spilled material see Chapter 13 of this Material Safety Data Sheet. Observe the relevant local and international regulations. Avoid contact with skin, eyes and clothing. Evacuate the area of all non - essential personnel. Ventilate contaminated area thoroughly. If contamination of sites occurs remediation may require specialist advice. Ensure electrical continuity by bonding and grounding (earthing) all equipment. Take precautionary measures against static discharges. Protective measures Vapour can travel for considerable distances both above and below the ground surface. Underground services (drains, pipelines, cable ducts) can provide preferential flow paths. Do not breathe fumes, vapour. Take measures to minimise the effects on groundwater. Contain residual material at affected sites to prevent material from entering drains (sewers), ditches, and waterways. Shut off leaks, if possible without personal risks. Remove all possible sources of ignition in the surrounding area. Use appropriate containment (of product and fire fighting water) to avoid environmental contamination. Prevent from spreading or entering drains, ditches or rivers by using sand, earth, or other appropriate barriers. Attempt to disperse the vapour or to direct its flow to a safe location for example by using fog sprays. Take precautionary measures against static discharge. Ensure electrical continuity by bonding and grounding (earthing) all equipment. Clean Up Methods For large liquid spills (> 1 drum), transfer by mechanical means such as vacuum truck to a salvage tank for recovery or safe disposal. Do not flush away residues with water. Retain as contaminated waste. Allow residues to evaporate or soak up with an appropriate absorbent material and dispose of safely. Remove contaminated soil and dispose of safely. For small liquid spills (< 1 drum), transfer by mechanical means to a labelled, sealable container for product recovery or safe disposal. Allow residues to evaporate or soak up with an appropriate absorbent material and dispose of safely. Remove contaminated soil and dispose of safely. Additional Advice Notify authorities if any exposure to the general public or the environment occurs or is likely to occur. Local authorities should be advised if significant spillages cannot be contained. Maritime spillages should be dealt with using a Shipboard Oil Pollution Emergency Plan (SOPEP), as required by MARPOL Annex 1 Regulation 26. U.S. regulations may require reporting releases of this material to the environment which exceed the reportable quantity (refer to Chapter 15) to the National Response Centre at (800) 424 -8802. Under Section 311 of the Clean Water Act (CWA) this material is considered an oil. As such, spills into surface waters must be reported to the National Response Centre at (800) 424 -8802. This material is covered by EPA's Comprehensive Environmental Response, 4117 Print Date 0 911 0/2 01 1 MSDS US 0 BR Conventional Gasoline with EtOH MSDS# 401730M Version 6.0 Effective Date 0910912011 Material Safety Data Sheet According to OSHA Hazard Communication Standard, 29 200 0 Compensation and liability Act (CERCLA) Petroleum Exclusion. Therefore, releases to the environment may not be reportable under CERCLA. 7. HANDLING AND STORAGE General Precautions Avoid breathing vapours or contact with material. Only use in well ventilated areas. Wash thoroughly after handling. For guidance on selection of personal protective equipment see Chapter 8 of this Material Safety Data Sheet. Use the information in this data sheet as input to a risk assessment of local circumstances to help determine appropriate controls for safe handling, storage and disposal of this material. Air -dry contaminated clothing in a well - ventilated area before laundering. Property dispose of any contaminated rags or cleaning materials in order to prevent fires. Prevent spillages. Turn off all battery operated portable electronic devices (examples include: cellular phones, pagers and CD players) before operating gasoline pump. Do not use as a cleaning solvent or other non -motor fuel uses. Contaminated leather articles including shoes cannot be decontaminated and should be destroyed to prevent reuse. For comprehensive advice on handling, product transfer, storage and tank cleaning refer to the product supplier. Handling When using do not eat or drink. Extinguish any naked flames. Do not smoke. Remove ignition sources. Avoid sparks. Never siphon by mouth. The vapour is heavier than air, spreads along the ground and distant ignition is possible. Avoid exposure. Storage Drum and small container storage: Keep containers closed when not in use. Drums should be stacked to a maximum of 3 high. Packaged product must be kept tightly closed and stored in a diked (bunded) well - ventilated area, away from, ignition sources and other sources of heat. Use properly labelled and closeable containers. Take suitable precautions when opening seated containers, as pressure can build up during storage. Tank storage: Tanks must be specifically designed for use with this product. Bulk storage tanks should be diked (bunded). Locate tanks away from heat and other sources of ignition. Cleaning, inspection and maintenance of storage tanks is a specialist operation, which requires the implementation of strict procedures and precautions. Product Transfer Electrostatic charges may be generated during pumping. Electrostatic discharge may cause fire. Ensure electrical continuity by bonding and grounding (earthing) all equipment. Restrict line velocity during pumping in order to avoid generation of electrostatic discharge (< 1 m/sec until fill pipe submerged to twice its diameter, then — 7 m/sec). Avoid splash filling. Do NOT use compressed air for filling, discharging, or handling operations. Wait 2 minutes after tank filling (for tanks such as those on road tanker vehicles) before opening hatches or manholes. Wait 30 minutes after tank filling (for large storage tanks) before opening hatches or manholes. Print Date 09/10/2011 5/17 MSDS_US BR Conventional Gasoline with EtOH MSDS# 401730M Version 6.0 Effective Date 09/09/2011 Material Safety Data Sheet According to OSHA Hazard Communication Standard, 1910.120D Recommended Materials For containers, or container linings use mild steel, stainless steel. Aluminium may also be used for applications where it does not present an unnecessary fire hazard. Examples of suitable materials are: high density polyethylene (HDPE), polypropylene (PP), and Viton (FKM), which have been specifically tested for compatibility with this product. For container linings, use amine - adduct cured epoxy paint. For seals and gaskets use: graphite, PTFE, Viton A, Viton B. Unsuitable Materials Some synthetic materials may be unsuitable for containers or container linings depending on the material specification and intended use. Examples of materials to avoid are: natural rubber (NR), nitrile rubber (NBR), ethylene propylene rubber (EPDM), polymethyl methacrylate (PMMA), polystyrene, polyvinyl chloride (PVC), polyisobutylene. However, some may be suitable for glove materials. Container Advice Containers, even those that have been emptied, can contain explosive vapours. Do not cut, drill, grind, weld or perform similar operations on or near containers. Gasoline containers must not be used for storage of other products. Additional Information Ensure that all local regulations regarding handling and storage facilities are followed. 8. EXPOSURE CONTROLS /PERSONAL PROTECTION Occupational Exposure Limits Material Source Type ppm mg/m3 Notation Gasoline, ACGIH TWA 300 ppm low boiling point naphtha Gasoline, ACGIH STEL 500 ppm low boiling point naphtha Toluene ACGIH TWA 20 ppm Toluene OSHA Z1A TWA 100 pprn 375 mg/m3 Toluene OSHA ZIIA STEL 150 ppim 560 mg/m3 Toluene OSHA Z2 TWA 200 ppm Toluene OSHA Z2 Ceiling 300 ppm Toluene OSHA Z2 MAX. CONC 500 opm Xylene, ACGIH TWA 100 ppm mixed isomers Xylene, ACGIH STEL 150 ppm mixed isomers Xylene, OSHA Z1 PEL 100 ppm 435 mg /m3 mixed isomers 6/17 Print Date 09/1012011 MSDS US W BR Conventional Gasoline with EtOH MSDS# 401730M Version 6.0 Effective Date 09/09/2011 Material Safe Data Sheet According to OSHA Hazard Communication Standard, 29 CFR 1910.1200 Xylene, mixed isomers OSHA Z1A TWA 100 ppm 435 mg /m3 Xylene, mixed isomers OSHA Z1A STEL 150 ppm 655 mg /m3 Ethanol ACGIH STEL -1,000-ppm Ethanol OSHAZI PEL 1,000 pprn 1,900m /m3 Ethanol OSHA ZIA TWA 1,000 ppm 1,900 mg/m3 1,2,4- Trimethylbe nzene ACGIH TWA 25 ppm 1,2,4- Trimethylbe nzene OSHA ZIA TWA 25 ppm 125 mg /m3 Ethylbenze ne ACGIH TWA 20 ppm Ethylbenze ne OSHA Z1 PEL 100 ppm 435 mg/m3 Ethylbenze ne OSHA ZIA TWA 100 ppm 435 mg /m3 Ethylbenze ne OSHA ZIA STEL 125 ppm 545 mg /m3 Benzene ACGIH TWA 0.5 ppm Benzene ACGIH STEL 2.5 pprn Benzene ACGIH SKIN-DES Can be absorbed through the skin. Benzene OSHA TWA I plim Benzene OSHA STEL 5 pprn Benzene OSHA OSHA-ACT 0.5 pprn Benzene OSHA ZIA TWA 1 pprn Benzene OSHA ZIA STEL 5 pprn Benzene SHELL IS TWA 0.5 ppm 1.6 m m3 Benzene SHELL IS STEL 2.5 ppm 8 m /m3 Benzene OSHA Z2 TWA 10 ppm Benzene OSHA Z2 Ceiling 25 ppm Benzene OSHA Z2 MAX. CONC 50ppm n- hexane ACGIH TWA 50 pprn n- hexane ACGIH SKIN_DES Can be absorbed through the skin. n- hexane OSHA Z1 PEL 500 pprn 1,800 m /m3 n- hexane OSHA Z1A TWA 50 m 180 mg/m3 Cyclohexan e ACGIH TWA 100 ppm Cyclohexan e OSHA Z1 PEL 300 ppm 1,050 mg /m3 Cyclohexan e OSHA ZIA TWA 300 ppm 1,050 mg/m3 Naphthalen e ACGIH TWA 10 ppm Print Date 09/10/2011 7117 MSDS_US SR Conventional Gasoline with EtOH MSDS# 401730M^Z Version 6.0 J Effective Date 0910912011 Material Safe Data Sheet According to OSHA Hazard Communication Standard, 29 CFR 1910.1200 Naphthalen e ACGIH STEL 15 ppm Reference Toluene Naphthalen e ACGIH SKIN—DES ACGIH BEL (01 Can be absorbed through the skin. Naphthalen e OSHA Z1 PEL 10 ppm 50 mg /m3 Sampling time: Naphthalen e OSHA Z1A TWA 10 ppm 50 mg /m3 Naphthalen e OSHA Z1A STEL 15 ppm 75 mg 1m3 Styrene ACGIH TWA 20 ppm, ACGIH BEL (01 Styrene ACGIH STEL 40 ppm Creatinine in Styrene OSHA ZIA TWA 50 ppm 215 m /m3 Styrene OSHA ZIA STEL 100 ppm 425 mg/m3 1.5 g/g S rene OSHA Z2 TWA 100 pprn 2010) Styrene OSHA Z2 Ceiling 200 pprn Styrene OSHA Z2 MAX. CONC 600 ppm Ethylbenzene Sum of mandelic Additional Information Shell has adopted as Interim Standards the OSHA Z 1 A values that were established in 1989 and later rescinded. SHELL IS is the Shell Internal Standard. Skin notation means that significant exposure can also occur by absorption of liquid through the skin and of vapour through the eyes or mucous membranes. Biolooical Exoosure Index (BEII - See reference for full details Material Determinant Sampling time BEI Reference Toluene toluene in Urine Sampling time: 0.03 mg/I ACGIH BEL (01 End of shift. 2010 Toluene toluene in Blood Sampling time: 0.02 mg /I ACGIH BEL (01 Prior to last shift 2010) of work week. Toluene o- Cresol, with Sampling time: 0.3 mg /g ACGIH BEL (01 hydrolysis in End of shift. 2010) Creatinine in urine Xylene, mixed isomers Methylhippuric Sampling time: 1.5 g/g ACGIH BEL (01 acids in End of shift. 2010) Creatinine in urine Ethylbenzene Sum of mandelic Sampling time: 0.7 g/g ACGIH BEL (01 acid and End of shift at 2010) phenylglyoxylic end of work acid in week. Creatinine in urine Ethylbenzene Ethyl benzene in Sampling time: ACGIH BEL (01 End - exhaled air Not critical. 2010 I 8/17 Print Date 0911012011 MSDS US 71 1 Material Safety Data Sheet SR Conventional Gasoline with EtOH MSDS# 401730M Version 6.0 Effective Date 09/09/2011 According to OSHA Hazard Communication Standard, 29 CFR 1910.1200 Benzene S- Sampling time: 25 pg /g ACGIH BEL (01 based on a risk assessment of local circumstances. Phenylmercaptu End of shift. 2010) ric acid in Local exhaust ventilation is recommended. Eye washes and showers for emergency use. Creatinine in Personal protective equipment (PPE) should meet Equipment recommended national standards. Check with PPE suppliers. Respiratory Protection urine to a level which is adequate to protect worker health, select Benzene M- Muconic acid Sampling time: 500 pg /g ACGIH BEL (01 in Creatinine in End of shift. mask and filter. Where air - filtering respirators are unsuitable 2010) (e.g. airborne concentrations are high, risk of oxygen urine deficiency, confined space) use appropriate positive pressure breathing apparatus. All respiratory protection equipment and n- hexane 2,5- Hexanedion, Sampling time: 0.4 mg /l ACGIH BEL (01 accordance with the requirements of the OSHA Respiratory without End of shift at Hand Protection 2010) hydrolysis in end of work hands should be washed and dried thoroughly. Application of a non - perfumed moisturizer is recommended. Suitability and Urine week. duration of contact, chemical resistance of glove material, Styrene styrene in Sampling time: 0.2 mg/1 ACGIH BEL (01 Venous blood End of shift. 2010 Styrene Mandelic acid Sampling time: 400 mg /g ACGIH BEL (01 plus End of shift. 2010) phenylglyoxylic acid in Creatinine in urine Exposure Controls The level of protection and types of controls necessary will vary depending upon potential exposure conditions. Select controls based on a risk assessment of local circumstances. Appropriate measures include: Use sealed systems as far as possible. Adequate explosion -proof ventilation to control airborne concentrations below the exposure guidelines /limits. Local exhaust ventilation is recommended. Eye washes and showers for emergency use. Personal Protective Personal protective equipment (PPE) should meet Equipment recommended national standards. Check with PPE suppliers. Respiratory Protection If engineering controls do not maintain airbome concentrations to a level which is adequate to protect worker health, select respiratory protection equipment suitable for the specific conditions of use and meeting relevant legislation. Check with respiratory protective equipment suppliers. Where air - filtering respirators are suitable, select an appropriate combination of mask and filter. Where air - filtering respirators are unsuitable (e.g. airborne concentrations are high, risk of oxygen deficiency, confined space) use appropriate positive pressure breathing apparatus. All respiratory protection equipment and use must be in accordance with local regulations. Respirator selection, use and maintenance should be in accordance with the requirements of the OSHA Respiratory Protection Standard, 29 CFR 1910.134. Hand Protection Personal hygiene is a key element of effective hand care. Gloves must only be wom on clean hands. After using gloves, hands should be washed and dried thoroughly. Application of a non - perfumed moisturizer is recommended. Suitability and durability of a glove is dependent on usage, e.g. frequency and duration of contact, chemical resistance of glove material, 9/17 Print Date 09 /10/2011 MSDS US BR Conventional Gasoline with EtOH MSDS# 401730M Version 6.0 Effective Date 09/0912011 Material Safety Data Sheet According to OSHA Hazard Communication Standard, 29 CFR Y 1910.1200 glove thickness, dexterity. Always seek advice from glove suppliers. Contaminated gloves should be replaced. Eye Protection Chemical splash goggles (chemical monogoggles). Protective Clothing Chemical resistant gloves /gauntlets, boots, and apron (where risk of splashing). 9. PHYSICAL AND CHEMICAL PROPERTIES Appearance : Bronze. Clear, bright liquid. Odour Hydrocarbon. pH Not applicable. Freezing Point -58 °C / -72 °F Flash point 40 °C / 40 °F (ASTM D -93 / PMCC) Upper / lower Flammability : 1.3 - 7.6 %(V) or Explosion limits liquids and gases, including carbon monoxide, carbon dioxide Auto-ignition temperature > 250 °C / 482 °F Specific gravity 0.72 - 016 Density ca. 0.78 g /cm3 at 15 °C / 59 °F Water solubility Negligible. Kinematic viscosity < 1 mm2/s at 40 °C / 104 °F Vapour density (air--1) 3.5 10. STABILITY AND REACTIVITY Stability Stable under normal conditions of use. Conditions to Avoid Avoid heat, sparks, open flames and other ignition sources. Materials to Avoid Strong oxidising agents. Hazardous Decomposition Hazardous decomposition products are not expected to form Products during normal storage. Thermal decomposition is highly Acute Dermal Toxicity dependent on conditions. A complex mixture of airborne solids, Acute Inhalation Toxicity liquids and gases, including carbon monoxide, carbon dioxide and other organic compounds will be evolved when this material undergoes combustion or thermal or oxidative degradation. 11. TOXICOLOGICAL INFORMATION Basis for Assessment Information given is based on product testing, and /or similar products, and /or components. Acute Oral Toxicity Low toxicity: L050 >2000 mg /kg , Rai Aspiration into the lungs when swallowed or vomited may cause chemical pneumonitis which can be fatal. Acute Dermal Toxicity Low toxicity: LD50 >2000 mg/kg , Rabbit Acute Inhalation Toxicity Low toxicity: LC50 >20 mg /I 11.00 h, Rat High concentrations may cause central nervous system depression resulting in headaches, dizziness and nausea; continued inhalation may result in unconsciousness and /or death. Skin Irritation Irritating to skin. Eye Irritation Moderately irritating to eyes (but insufficient to classify). Respiratory Irritation Based on human experience, breathing of vapours or mists may cause a temporary burning sensation to nose, throat and 10/17 Print Date 09110/2011 MSDS US IN SR Conventional Gasoline with EtOH MSDS# 401730M Version 6.0 Effective Date 09/09/2011 Material Safety Data Sheet According to OSHA Hazard Communication Standard, 29 CFR Y 1910.1200 Material lungs. Sensitisation Not expected to be a sensitiser. Repeated Dose Toxicity Kidney: caused kidney effects in male rats which are not Gasoline, low boiling point naphtha considered relevant to humans I IARC 2B: Possibly carcinogenic to humans. Blood - forming organs: repeated exposure affects the bone marrow. (Benzene) X lene. mixed isomers Peripheral nervous system: repeated exposure causes IARC 3: Not classifiable as to carcinogenicity to humans. peripheral neuropathy in animals. (n- hexane) Mutagenicity May cause heritable genetic damage. (Benzene) Toluene Mutagenicity studies on gasoline and gasoline blending IARC 3: Not classifiable as to carcinogenicity to humans. streams have shown predominantly negative results. Carcinogenicity Known human carcinogen. (Benzene) Ethylbenzene May cause leukaemia (AML - acute myelogenous leukemia). ACGIH Group A3: Confirmed animal carcinogen with unknown relevance to humans. (Benzene) Inhalation exposure to mice causes liver tumours, which are Benzene not considered relevant to humans. Material Causes foetotoxicity at doses which are maternally toxic. Carcinogenicity Classification Gasoline, low boiling point naphtha ACGIH Group A3: Confirmed animal carcinogen with unknown relevance to humans. Gasoline, low boiling point naphtha : I IARC 2B: Possibly carcinogenic to humans. X lene, mixed isomers ACGIH Group A4: Not classifiable as a human carcinogen, X lene. mixed isomers I IARC 3: Not classifiable as to carcinogenicity to humans. Toluene ACGIH Group A4: Not classifiable as a human carcinogen. Toluene Exposure to very high concentrations of similar materials has been irregular heart rhythms and cardiac IARC 3: Not classifiable as to carcinogenicity to humans. Ethanol ACGIH Group A4: Not classifiable as a human carcinogen. Ethylbenzene MSDS US ACGIH Group A3: Confirmed animal carcinogen with unknown relevance to humans. Eth benzene IARC 28: Possibly carcinoge nic to humans. Benzene ACGIH Grou A1: Confirmed human carcinogen. Benzene ! NTP: Known carcinogen. Benzene IARC 1: Carcinogenic to humans. Benzene i ; OSHASP: Cancer hazard. Naphthalene i I ACGIH Group A4: Not classifiable as a human carcinogen. Naphthalene I I NTP: Anticipated carcinogen- Naphthalene I IARC 2B: Possibly carcinogenic to humans. Styrene I ACGIH Group A4: Not classifiable as a human carcinogen, Styrene NTP: Reasonably anticipated to be a human carcinogen. Styrene ibly carcinogenic to humans. Reproductive and Causes foetotoxicity at doses which are maternally toxic. Developmental Toxicity (Toluene) May impair fertility at doses which produce other toxic effects. (n- hexane) Many case studies involving abuse during pregnancy indicate that toluene can cause birth defects, growth retardation and leaming difficulties. (Toluene) Ethanol, a component of this material, may cause birth defects and /or miscarriages following high oral doses. Additional Information Exposure to very high concentrations of similar materials has been irregular heart rhythms and cardiac associated with 11/17 Print Date 09/1012011 MSDS US SR Conventional Gasoline with EtOH MSDS# 401730M Version 6.0 Effective Date 09/09/2011 Material Safety Data Sheet According to OSHA Hazard Communication Standard, 29 CFR y 1910.1200 arrest. Prolonged and repeated exposures to high concentrations have resulted in hearing loss in rats. Solvent abuse and noise interaction in the work environment may cause hearing loss. (Toluene) Abuse of vapours has been associated with organ damage and death. (Toluene) May cause MDS (Myelodysplastic Syndrome). (Benzene) 12. ECOLOGICAL INFORMATION Incomplete ecotoxicological data are available for this substance. Acute Toxicity : Toxic: LLIEUIL50 1 -10 mg/I (to aquatic organisms) (LUEL50 expressed as the nominal amount of product required to prepare aqueous test extract). Fish Expected to be toxic: LUEUI1-50 1 -10 mg /l Aquatic Invertebrates Expected to be toxic: LUEUIL50 1 -10 mg 11 Algae Expected to be toxic: LUEUIL501 -10 mg /l Microorganisms Expected to be harmful: LUEUI1-50 10 -100 mg/I Mobility Floats on water. Evaporates within a day from water or soil surfaces. Large volumes may penetrate soil and could contaminate groundwater. Contains volatile constituents. Persistence /degradability Major constituents are expected to be inherently biodegradable. The volatile constituents will oxidize rapidly by photochemical reactions in air. Bioaccumulation Expected to be inherently biodegradable. Contains constituents with the potential to bioaccumulate. Other Adverse Effects Films formed on water may affect oxygen transfer and damage organisms. 13. DISPOSAL CONSIDERATIONS Material Disposal : Recover or recycle if possible. It is the responsibility of the waste generator to determine the toxicity and physical properties of the material generated to determine the proper waste classification and disposal methods in compliance with applicable regulations. Waste arising from a spillage or tank cleaning should be disposed of in accordance with prevailing regulations, preferably to a recognised collector or contractor. The competence of the collector or contractor should be established beforehand. Do not dispose into the environment, in drains or in water courses. Do not dispose of tank water bottoms by allowing them to drain into the ground. This will result in soil and groundwater contamination. Container Disposal Drain container thoroughly. After draining, vent in a safe place away from sparks and fire. Residues may cause an explosion hazard. Do not, puncture, cut, or weld uncleaned drums. Send to drum recoverer or metal rectaimer. Do not pollute the soil, water or environment with the waste container. Local Legislation Disposal should be in accordance with applicable regional, 12/17 Print Date 09/10/2011 MSDS US SR Conventional Gasoline with EtOH MSDS# 401730M Version 6.0 Effective Date 09/09/2011 Material Safety Data Sheet According to OSHA Hazard Communication Standard 129 CFR 0.1200 national, and local laws and regulations. Local regulations may be more stringent than regional or national requirements and must be complied with. 14. TRANSPORT INFORMATION US Department of Transportation Classification (49CFR) Identification number UN 1203 Proper shipping name Gasohol Class / Division 3 Packing group Emergency Response Guide No. Additional Information IMDG ^^+ Identification number Proper shipping name Class / Division Packing group Marine pollutant: 128 Oil: This product is an oil under 49CFR (DOT) Part 130. If shipped by rail or highway in a tank with a capacity of 3500 gallons or more, it is subject to these requirements. Mixtures or solutions containing 10% or more of this product may also be subject to this rule. UN 1203 GASOLINE 3 11 Yes IATA (Country variations may apply) Identification number UN 1203 Proper shipping name Gasoline Class / Division 3 Packing group II 15. REGULATORY INFORMATION The regulatory information is not intended to be comprehensive. Other regulations may apply to this material. Federal Regulatory Status Additional Information IARC has classified gasoline exhaust emissions as a Class 2B carcinogen - possibly carcinogenic to humans. Steps should be taken to prevent personal exposure to gasoline exhaust emissions. Comprehensive Environmental Release, Compensation & Liability Act (CERCLA) t BR Conventional Gasoline with Reportable quantity: 100 Ibs 13/17 Print Date 09/10/2011 MSDS_US Clean Water Act (CWA) Section 311 Xylene, mixed isomers (1330 -20 -7) SR Conventional Gasoline with EtOH Toluene (108 -88 -3) MSDS# 401730M Ethylbenzene (10041 -4) Version 6.0 Benzene (71 -43 -2) Effective Date 09/09/2011 Material Safety data Sheet According to OSHA Hazard Communication Standard, 29 CFR 1910.1200 EtOH () Cyclohexane (110 -82 -7) Gasoline, low boiling point naphtha () Reportable quantity: 100 lbs Xylene, mixed isomers (1330 -20-7) Reportable quantity: 100 lbs Toluene (108 -88-3) Reportable quantity: 1000 lbs Ethanol (64 -17 -5) Reportable quantity: 100 lbs Ethylbenzene (100 -41-4) Reportable quantity: 1000 lbs Benzene (71 -43-2) Reportable quantity: 10 lbs; n- hexane (110 -54 -3) Reportable quantity: 5000 lbs Naphthalene (91 -20 -3) Reportable quantity: 100 lbs Cyclohexane (110 -82 -7) Reportable quantity: 1000 lbs Styrene (100 -42 -5) Reportable quantity: 1000 lbs Shell classifies this material as an 'oil" under the CERCLA Petroleum Exclusion, therefore releases to the environment are not reportable under CERCLA. Clean Water Act (CWA) Section 311 Xylene, mixed isomers (1330 -20 -7) Reportable quantity: 100 lbs Toluene (108 -88 -3) Reportable quantity: 1000 lbs Ethylbenzene (10041 -4) Reportable quantity: 1000 lbs Benzene (71 -43 -2) Reportable quantity: 10 lbs Naphthalene (91 -20 -3) Reportable quantity: 100 lbs Cyclohexane (110 -82 -7) Reportable quantity: 1000 lbs Styrene (100 -42 -5) Reportable quantity: 1000 lbs Under Section 311 of the Clean Water Act (CWA) this material is considered an oil. As such, spills into surface waters must be reported to the National Response Centre at (800) 424 - 8802.^, 1 SARA Hazard Categories (3111312) 14/17 Print Date 09/10/2011 MSDS_US SR Conventional Gasoline with VON MSDS# 401730M Version 6.0 Effective Date 09!0912011 Material Safety Data Sheet According to OSHA Hazard Communication Standard, 29 CFR Y 1910.1200 Immediate (Acute) Health Hazard. Delayed (Chronic) Health Hazard. Fire Hazard. SARA Toxic Release Inventory (TRI) (313) Xylene, mixed isomers (1330 -20-7) Toluene (108 -88-3) 1,2,4 - Trimethylbenzene (95 -63 -6) Ethylbenzene (100 -41-4) Benzene (71-43-2) n- hexane (110 -543) Naphthalene (91 -20 -3) Cyclohexane (110 -82 -7) Styrene (100 -42 -5) State Regulatory Status California Safe Drinking Water and Toxic Enforcement Act (Proposition 65) This product contains a chemical known to the State of California to cause cancer. Known to the State of California to cause birth defects or other reproductive harm. New Jersey Right- To-Know Chemical List Xylene, mixed isomers (1330 -20-7) Listed. Toluene (106 -88-3) Listed. Ethanol (6417 -5) Listed. 1,2,4- Trimethylbenzene (95 -63-6) Listed. Ethylbenzene (100 -41-4) Listed. Benzene (71 -43-2) Listed. n- hexane (110 -543) Listed. Naphthalene (91 -20-3) Listed. Cyclohexane (110 -82 -7) Listed. Styrene (100 -42 -5) Listed. Pennsylvania Right- To-Know Chemical List Gasoline, low boiling point naphtha () Listed. Xylene, mixed isomers (1330 -20-7) Environmental hazard_ Listed. Toluene (108 -88-3) Environmental hazard. Ethanol Listed. Listed. ( (64 -17 -5) 15117 Print Date 09/10/2011 MSDS US Material Safety Data Sheet 1,2,4- Trimethylbenzene (95 -63-6) Ethylbenzene (100 -41-4) Benzene (71 -43-2) n- hexane (110 -54 -3) Naphthalene (91 -20-3) Cyclohexane (110 -82 -7) Styrene (100 -42 -5) 16. OTHER INFORMATION BR Conventional Gasoline with EtOH MSDS# 401730M Version 6.0 Effective Date 09/09/2011 According to OSHA Hazard Communication Standard, 29 CFR 1910.1200 Environmental hazard. Listed. Environmental hazard. Listed. Special hazard. Environmental hazard. Listed. Listed. Environmental hazard. Listed. Environmental hazard. Listed. Environmental hazard. Listed. Additional Information : This document contains important information to ensure the safe storage, handling and use of this product. The information in this document should be brought to the attention of the person in your organisation responsible for advising on safety matters. NFPA Rating (Health, 1, 3, 0 Fire, Reactivity) MSDS Version Number 6.0 MSDS Effective Date 09/09/2011 MSDS Revisions A vertical bar (p in the left margin indicates an amendment from the previous version. MSDS Regulation The content and format of this MSDS is in accordance with the OSHA Hazard Communication Standard, 29 CFR 1910.1200. Uses and Restrictions This product must not be used in applications other than those recommended in Section 1, without first seeking the advice of the supplier. This product is not to be used as a solvent or cleaning agent; for lighting or brightening fires; as a skin cleanser. This product is designed only to suit automotive applications and no provision is made for the requirements of aviation applications. MSDS Distribution The information in this document should be made available to all who may handle the product. Disclaimer : The information contained herein is based on our current knowledge of the underlying data and is intended to describe the product for the purpose of health, safety and environmental requirements only. No warranty or guarantee is expressed or implied regarding the accuracy of these data or the results to be obtained from the use of the product. 16/17 Print Date 09/10/2011 MSDS US 0 BR Conventional Gasoline with EtOH MSDS# 401730M Version 6.0 Effective Date 09109/2011 Material Safety Data Sheet According to OSHA Hazard Communication Standard, 29 CFR 1910.1200 17117 Print Date 09110!2011 MSDS US CERTIFICATE OF OCCUPANCY WORKORDER PERMIT # 12- 3,5 %,,Z ADDRESS OF INSPECTION: DATE OF INSPECTION: , 411a& NAME OF BUSINESS: TYPE OF BUSINESS: USE OF BUILDING AND /OR PREMISES: L2 REASON FOR APPLYING: CONTACT PERSON: TELEPHONE NUMBER: � /ZI - COMMENTS /VIOLATIONS�—_� %, TIME OF INSPECTION: * *TO BE FILLED OUT BY BUILDING OFFICIAL ** ZONING DISTRICT OF INSPECTION LOCATION: C c TYPE OF BUILDING: 71zg GROUP AND DIVISION: ZONING RESTRICTIONS: O. FO,-MS DSCOINFORMATION WORKORDER 12 30 04 Rcv i I' 2006