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Disposition of material recovered from the incident ( attach additional sheets as necessary): <br />Quantity of material recovered from the incident: <br />Emergency actions taken during the incident: <br />13. Agencies notified: <br />Agency <br />14. Agencies responding: <br />Agency <br />Respectfully submitted, <br />By: <br />Signature: <br />Notification Time <br />Notification Time <br />Title: <br />Date: <br />Person Contacted <br />Person Contacted <br />Revised 3/1/2013 17 <br />