14-18 Exhibit-Application for Discharge Site Remediation Funds from HDSRF.pdf

Exhibit “A”

New Jersey Department of Environmental Protection Site Remediation Program HAZARDOUS DISCHARGE SITE REMEDIATION FUND – PART I Date Stamp LSRP Subsurface Evaluator (for UHOT cases only) (For Department use only) SECTION A. REQUESTED FUNDING TYPE AND AMOUNT PLEASE CHECK HERE IF INITIAL APPLICATION HAS BEEN SUBMITTED Public Entity Brownfield Development Area Grant ...........................................$ 375,000.00 PA/SI/RI Grant .............................................................................$ 75% Recreation and Conservation Grant ....................................$ 21,000.00 Block 7, Lot 22 75% Renewable Energy Grant ....................................................$ 50% Affordable Housing Grant ....................................................$ 25% Matching Grant Remedial Action(LR/UR) ...........................$ 25% Matching Grant Innovative Technology ...............................$ Loan .............................................................................................$ Private Entity 50% Innocent Party Grant ...........................................................$ 25% Matching Grant Remedial Action(LR/UR) ...........................$ 25% Matching Grant Innovative Technology ...............................$ Loan .............................................................................................$ Non-Profit PA/SI/RI Grant .............................................................................$ SECTION B. APPLICANT INFORMATION Name: Township of West Orange Address: 66 Main Street City: West Orange State: New Jersey County: Essex Zip Code: 07052 Phone Number: (973) 325-4160 Ext: Fax: Email Address: JSayers@westorange.org Individual: Social Security Number: Businesses:

25-4160 Ext: Fax: Email Address: JSayers@westorange.org Individual: Social Security Number: Businesses: Tax ID Number: SIC: NIAC: SECTION C. CONTACT INFORMATION Check here if contact information is the same as Section B above (proceed to Section D) Contact Person: John K. Sayers Title: Business Administrator Affiliation: Township of West Orange Address: 66 Main Street City/Town: West Orange State: NJ Zip Code: 07052 Phone Number: (973) 325-4160 Ext: Fax: Email Address: JSayers@westorange.org HDSRF Application Part I Page 1 of 4 Version 1.3 12/11/13

SECTION D. SITE OWNERSHIP INFORMATION Check here if site ownership information is the same as Section B above (proceed to Section E) Name of Site Owner: Address: City/Town: State: Zip Code: SECTION E. SITE INFORMATION (location where remediation will be conducted) Name of Site (as identified on NJDEP’s Known Contaminated Site List): SELECTO FLASH SAFETY INC PI (Program Interest) Number: 027054 & 757936 Acreage: 1.5 Other Site Names (A.K.A.): SELECTO FLASH INC Address: 18 CENTRAL AVE & 4 TOMPKINS STREET City: West Orange State: New Jersey County: Essex Zip Code: 07052 Municipal Block(s) and Lot(s): Block 9, Lot 36 & Block 7, Lot 22 SECTION F. EXISTING CASE Have remediation activities been performed at the site? ...................................................................................... Yes No If “Yes,” provide the name of the site: ______________________________________________________________ 027054 & 757936 SRP Preferred ID No.: _______________________ 95-10-18-1521-31/ E86935 Case Tracking No.: __________________________ SECTION G. VIOLATIONS, PENALTIES & FEES Any applicant that is not in compliance with all applicable DEP regulation must submit a written description and explanation for noncompliance including a list of all violations and outstanding fees and penalties to be provided below. Applicant’s must specify whether the violations, fees or penalties are currently being contested in a manner prescribed by law and whether the violations, fees and penalties resulted from a lack of financial resources to perform required remediation. According to NJDEP Dataminer, only one outstanding violation exists for the Selecto Flash property. Program Description: Site Remediation Program Interest Type: SRP-PI Activity Number: PEA 110001 Program Interest ID: 027054 Document Type: SRP Directive Description of Non-compliance: Failed to conduct remediation

: Site Remediation Program Interest Type: SRP-PI Activity Number: PEA 110001 Program Interest ID: 027054 Document Type: SRP Directive Description of Non-compliance: Failed to conduct remediation in accordance with N.J.A.C. 7:26C Discovery Activity Number: SUB 110001 Discovery Date: 2/9/2011 Violated Citation: [N.J.A.C. 7:1E-5.7(a)2ii] Violation Status: Pending Compliance Due Date: N/A HDSRF Application Part I Page 2 of 4 Version 1.3 12/11/13

SECTION H. OTHER FUNDING SOURCES Indicate all other sources of financial assistance sought for the remediation of the site. Check here if no other funding sought Insurance Coverage NJRA Brownfield Redevelopment Initiative UST Fund Green Acres 75% Brownfield Reimbursement NJ Environmental Infrastructure Trust Entity(s) responsible for conducting the remediation Other: ____________________________________________ SECTION I. WORK PROPOSAL Attach Work Proposal to application. Name of Company Preparing the Work Proposal: Matrix New World Engineering Preparer Name: Tamara Grillon Phone: (973) 585-5267 Email Address: tgrillon@matrixneworld.com SECTION J. COST ESTIMATE Attach Detailed Cost Estimate to application. SECTION K. DEMONSTRATION OF NEED FOR LOAN APPLICANTS N/A Loan applicants must demonstrate that they cannot obtain commercial funding by submitting denial letters from two lending institutions. Provide letters with application. SECTION L. FINANCIAL INFORMATION (Private Entities, Except for Innocent Party Applicants) N/A Homeowners must submit Federal tax returns for the last three years. Businesses and private matching grant applicants must attach business, as well as personal, financial statements for the last three years. Provide financial information with application. HDSRF Application Part I Page 3 of 4 Version 1.3 12/11/13

SECTION M. LICENSED SITE REMEDIATION PROFESSIONAL INFORMATION AND STATEMENT LSRP ID Number: 668140 First Name: Rose Last Name: DeLorenzo Phone Number: (973) 585-9034 Ext: Fax: (973) 240-1818 Mailing Address: 26 Columbia Turnpike City/Town: Florham Park State: NJ Zip Code: 07932 Email Address: rdelorenzo@matrixneworld.com This statement shall be signed by the LSRP who is submitting this notification in accordance with SRRA Section 16 d. and Section 30 b.2. I certify that I am a Licensed Site Remediation Professional authorized pursuant to N.J.S.A. 58:10C to conduct business in New Jersey. As the Licensed Site Remediation Professional of record for this remediation, I: [SELECT ONE OR BOTH OF THE FOLLOWING AS APPLICABLE]: directly oversaw and supervised all of the referenced remediation, and\or personally reviewed and accepted all of the referenced remediation presented herein. I believe that the information contained herein, and including all attached documents, is true, accurate and complete. It is my independent professional judgment and opinion that the remediation conducted at this site, as reflected in this submission to the Department, conforms to, and is consistent with, the remediation requirements in N.J.S.A. 58:10C-14. My conduct and decisions in this matter were made upon the exercise of reasonable care and diligence, and by applying the knowledge and skill ordinarily exercised by licensed site remediation professionals practicing in good standing, in accordance with N.J.S.A. 58:10C-16, in the State of New Jersey at the time I performed these professional services. I am aware pursuant to N.J.S.A. 58:10C-17 that for purposely, knowingly or recklessly submitting false statement, representation or certification in any document or information submitted to the board or Department, etc., that there are significant civil, administrative and criminal penalties, including license revocation or suspension, fines and being punished by imprisonment for conviction of a crime of the third degree. LSRP Signature: Date: LSRP Name/Title: Rose V. DeLorenzo, CHMM, LSRP Company Name:

of a crime of the third degree. LSRP Signature: Date: LSRP Name/Title: Rose V. DeLorenzo, CHMM, LSRP Company Name: Matrix New World Engineering No changes to contact information since last submission Completed forms should be sent to: Bureau of Case Assignment & Initial Notice Site Remediation Program NJ Department of Environmental Protection 401-05H PO Box 420 Trenton, NJ 08625-0420 HDSRF Application Part I Page 4L of 4 Version 1.3 12/11/13

SECTION M. SUBSURFACE EVALUATOR INFORMATION AND STATEMENT N/A I certify under penalty of law that the work was performed under my oversight and I have reviewed the report and all attached documents, and the submitted information is true, accurate and complete in accordance with the requirements of N.J.A.C. 7:14B and N.J.A.C. 7:26E. I am aware that there are significant civil and criminal penalties for submitting false, inaccurate or incomplete information including fines and/or imprisonment. Name: UST Cert. No.: Firm: Firm’s UST Cert. Number: Firm Address: City/Town: State: Zip Code: Phone Number: Ext: Fax: Signature: Date: No Changes To Contact Information Since Last Submission Completed forms should be sent to: Bureau of Case Assignment & Initial Notice Site Remediation Program NJ Department of Environmental Protection 401-05H PO Box 420 Trenton, NJ 08625-0420 HDSRF Application Part I Page 4SE of 4 Version 1.3 12/11/13

New Jersey Department of Environmental Protection Site Remediation Program HDSRF APPLICATION – GENERAL CERTIFICATION – PART II THIS CERTIFICATION IS REQUIRED TO BE COMPLETED BY ALL APPLICANTS This certification shall be signed as follows: for a corporation, by a principal executive officer, at least the level of vice president; for a partnership, by a general partner; for a sole proprietorship, by the proprietor; for a public entity, the contact person (administrator, township manager, etc.); for other than above (i.e. homeowner/individual), the person with legal responsibility for the site. I certify under penalty of law that I have personally examined and am familiar with the information submitted herein and all attached documents, and that based on my inquiry of those individuals immediately responsible for obtaining the information, I believe that the submitted information is true, accurate and complete. I am aware that there are significant civil penalties for knowingly submitting false, inaccurate or incomplete information and that I am committing a crime of the fourth degree if I make a written false statement which I do not believe to be true. I am aware that if I knowingly direct or authorize the violation of any statute, I am personally liable for the penalties. Signature Name/Title Township of West Orange Company Sworn to and Subscribed Before Me On this date of Notary HDSRF Application Part II Page 1 of 1 Version 1.3 12/11/13