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

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