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If no Scribe is assigneohen <br /> Safety Officer fills out this form <br /> Name of person filling out this form: Kevin Selby <br /> Date and time event started: 8/12/2011 7:20 am <br /> Name of Incident Commander(and time assigned): Kevin Selby <br /> Name of Safety Officer(and time assigned): Doug DuBoce <br /> Name of Operations Officer(and time assigned): N.A. <br /> Name of Logistics Officer(and time assigned): N.A. <br /> Other people helping with the response(and their assigned roles): Bunrith So <br /> Notifications made: <br /> Time <br /> Called? Who talked to? Control Number Who Called? <br /> Fire Department <br /> State OES <br /> EPA National Response Center 7:57am Jerry hardy ' 985712 Kevin S. <br /> County Health Department 7:36am Rodney <br /> 8:00am Estrada N.A. Kevin S. <br /> Safety Manager N.A. <br /> Operations Manager <br /> Chief Engineer/Maintenance Mgr. 7:20 am <br /> Other <br /> What time did the Fire Department arrive? N.A. am pm <br /> Is anyone experiencing any symptoms of chemical exposure? NO <br /> What is being done about this person's symptoms NIA First Aid Fire Dept. Clinic Hospital <br /> Has this person's family been notified? N/A YES NO By whom: <br /> Scribe Form (9-28-09) Page 1 of 2 <br />