MIME-Version: 1.0 Content-Type: multipart/related; boundary="----=_NextPart_01C804E9.4FFC6050" This document is a Single File Web Page, also known as a Web Archive file. If you are seeing this message, your browser or editor doesn't support Web Archive files. Please download a browser that supports Web Archive, such as Windows® Internet Explorer®. ------=_NextPart_01C804E9.4FFC6050 Content-Location: file:///C:/8F33DDE2/CHAPTERV-B.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" DATE TIME A

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DATE        =             &nb= sp;     TIME         =             &nb= sp;   A. M./P. M.   NOTIFICATION NO.         =              OF _________

 

FACILITY/TRANSPORTER        =             &nb= sp;            =              INCIDENT LOCATION_____________________    

 

CALLER’S NAME             =             &nb= sp;            =             &nb= sp;       CALLER’S TITLE  ___________________________    

 

EMERGENCY CLASSIFICATION (Circle)

Level 1       =             L= evel 2       =             L= evel 3       =             L= evel 4        =    (See definitions in Chapter V, Appendix “C”)

 

HAZARDOUS MATERIAL DATA

Name        =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =     Quantity Released =  __________________________ 

Duration of Release        =             &nb= sp;            =      Medium of Release   Air        &= nbsp;  Water     Ground

Wind Direction        =               =             &nb= sp;         Wind Speed        =             &nb= sp;            =     Temperature __________________          =             

Existing Location&= nbsp; ________________________________________________________________= ____________

Potential Area of Impact ______________________= __________________________________________________

Health Effects&nbs= p; ________________________________________________________________= ________________

 

 

AGENCIES INFORMED     &= nbsp;           &nbs= p;            &= nbsp;    CONTACT        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp; TIME

____________________________           &nb= sp;            =        ____________________________        &= nbsp;           &nbs= p;          ___________= _________

____________________________           &nb= sp;            =        ____________________________        &= nbsp;           &nbs= p;          ___________= _________

____________________________           &nb= sp;            =        ____________________________        &= nbsp;           &nbs= p;          ___________= _________

____________________________           &nb= sp;            =        ____________________________        &= nbsp;           &nbs= p;          ___________= _________

____________________________           &nb= sp;            =        ____________________________        &= nbsp;           &nbs= p;          ___________= _________        =                 =             &nb= sp;            =             &nb= sp;          <= span style=3D'mso-spacerun:yes'>        =            =             &nb= sp;            =             &nb= sp;            =          =          =          =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =                 =            =             &nb= sp;            =             &nb= sp;            =          =          =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =            =               =            =             &nb= sp;            =             &nb= sp;            =          =          =             &nb= sp;            =         

 

 

STATUS REPORT

______________________________________________________= ___________________________________________________________________________= ___________________________________________________________________________= ___________________________________________________________________________= ___________________________________________________________________________= ___________________________________________________________________________= ____________________________________        =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;              =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;                  =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;                  =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;                  =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;      

 

RECOMMENDED PROTECTIVE ACTION (Circle)

None        &= nbsp;           &nbs= p; Shelter - In - Place     &= nbsp;           &nbs= p;             = Prepare - To - Evacuate    &nbs= p;            &= nbsp;   Evacuate

 

ASSISTANCE REQUIRED (Circle)

None        &= nbsp;           &nbs= p; Fire        &= nbsp;           &nbs= p;    Law Enforcement     &n= bsp;            = ;             <= /span>EMS        &= nbsp;           &nbs= p;  Other  _______________________

 

FACILITY/TRANSPORTER ADVISOR SENT TO EMERGENCY OPER= ATIONS ROOM (Circle)

Yes        &= nbsp;           &nbs= p;    No        &= nbsp;           &nbs= p;      On The Way

 

 

 

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CHAPTER V<= /span>

APPENDIX “BR= 21;

 

EARLY WARNING SIGNAL AND COMMUNICATIONS PLAN

 =

HAZARDOUS MATERIALS EMERGENCY NOTIFICATION FORM<= o:p>

REVISED – SEPTE= MBER 1998

1

REVISED - SEPTEMBER 1998

1

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