Hazardous Materials Response Claims

Mark Deaver Village Fire Chief Fire/EMS Department (Non Emergency) Ken Voss 715-345-5310 Village Deputy Fire Chief

Tim Cisewski (Emergency) 911 VILLAGE OF PLOVER Village Assistant Chief 2400 POST ROAD, PO Box 37

PLOVER, WISCONSIN 54467 www.ploverfd.org

MEMORANDUM

TO: James Williams, Emergency Management Deputy Director

FROM: Kenneth Voss, Deputy Fire Chief

CC: Bob Weinert, Emergency Management Director Mark Deaver, Fire Chief David Lutz, Monogram Appetizers

DATE: January 24, 2020

RE: Hazardous Material Incident Response Reimbursement Request Incident No. 19-0001731, Monogram Appetizers, 300 Moore Rd. Village of Plover ======

Enclosed please find a reimbursement request for the Local Emergency Planning Committee (LEPC) consideration from the Village of Plover Fire Department (i.e. Haz-Mat Team, Traffic Incident Management Team) for the hazardous material release which occurred on Monday, December 16, 2019 at Monogram Appetizers, 300 Moore Road, Village of Plover.

The Village of Plover Fire/EMS Department reimbursement is for a total of $8,450.99. Plover Fire Department provided hazardous material response for this incident.

Please let me know if you have any question regarding the enclosed reimbursement request. We greatly appreciate your time and assistance in processing this request.

Portage County

715-346-1398 1500 Strongs Avenue, Stevens Point, WI 54481 Incident No. 19-0001731 Date of Spill December 16, 2019 Location Monogram Appetizers, 300 Moore RD, Plover, WI 54467

Agency Requesting Reimbursement Village of Plover Fire Department Tax ID # 39-1154795 Maililng Address P.O. Box 37 Plover, WI 54467

** THIS MUST BE ACCOMPANIED BY A WRITTEN REPORT ** Number Type of Equipment/Supplies Number of Personnel Rate/Cost Qty of Hrs Total Fire Chief 1 $63.35 4 $253.40 Deputy Fire Chief 1 $56.19 4 $224.76 Assistant Fire Chief - Full-Time 1 $50.83 4 $203.32 Assistant Fire Chief - POC 2 $15.94 4 $127.52 Fire Medic - Full-Time 1 $39.26 4 $157.04 Fire Captain 2 $15.30 2 4 $244.80 Fire Lieutenant 3 $14.66 8 4 $1,407.36 Motor Pump Operator 1 $14.46 4 $57.84 Fire Fighter 5 $14.25 4 $285.00 Emergency Medical Responder 1 $11.10 4 $44.40 Emergency Medical Technician (PT) 1 $13.32 4 $53.28 Squad $100.00 3 4 $1,200.00 Engine $340.00 2 4 $2,720.00 Command Post $175.00 1 4 $700.00 Ambulance 1 4 $4.00

Subtotal $7,682.72 Administrative Cost - 10% of Subtotal $768.27 Total $8,450.99

Reimbursement Rates (discussed at County Chiefs and distributed to all agencies): Mileage: Same as IRS or County Reimbursement Rate Personnel: Actual Cost (by contract or agreement) Expendable Equipment/Supplies: Actual Repllacement Cost Per Unit per/hour (1 hr minimum): Engine, Fire (Pumper)* $340 Fire Truck - Aerial (Ladder or Platform)* $365 Water Tender, Firefighting (Tanker)* $320 Command Post $175 Squad (Fire)* $100 Ambulance Current Portage County Stand-By Rate Other Units* By pre-approved agreement

Other rates will be considered with proper documentation and justification *FEMA 508-4 Typed Resource Definitions March 2012 MM DD A YYYY Delete NFIRS -1 49080WI 12 16 2019 01 19-0001731 000 X Change Basic FDID State Incident Date Station Incident Number Exposure ***** No Activity Check this box to Indicate that the address for this incident is provided on the Wildland Fire Census Tract B Location* Module In Section B "Alternative Location Specification". Use only for Wildland fires. - X Street address 300 Moore Intersection RD Number/Milepost Prefix Street or Highway Street Type Suffix In front of - Rear of Plover WI 54467 Apt./Suite/Room City State Zip Code Adjacent to Directions Cross street or directions, as applicable Midnight is 0000 C Incident Type * E1 Date & Times E2 Shift & Alarms 112 Fires in structure other than Check boxes if Month Hr Min Sec Local Option dates are the Day Year Incident Type same as Alarm ALARM always required PFD Date. Aid Given or Received Alarm 12 16 2019 00:11:00 Shift or Alarms District D * * Platoon ARRIVAL required, unless canceled or did not arrive 1 Mutual aid received 49010 WI X Arrival 12 16 2019 00:22:00 2 X Automatic aid recv. Their FDID Their * E3 State 3 Mutual aid given CONTROLLED Optional, Except for wildland fires Special Studies Local Option 4 Automatic aid given Controlled 5 Other aid given Their LAST UNIT CLEARED, required except for wildland fires Incident Number Last Unit Special None Special N X Cleared 12 16 2019 04:06:00 Study ID# Study Value F Actions Taken * G1 Resources * G2 Estimated Dollar Losses & Values Check this box and skip this X section if an Apparatus or LOSSES: Required for all fires if known. Optional for non fires. None 86 Investigate Personnel form is used. Apparatus Personnel Property 000 000 Primary Action Taken (1) $ ,, Suppression 0008 0019 Contents $ , 000, 000 41 Identify, analyze Additional Action Taken (2) EMS PRE-INCIDENT VALUE: Optional Other 48 Remove hazardous Property $ , 000 , 000 Additional Action Taken (3) Check box if resource counts include aid received resources. Contents $ , 000 , 000 Completed Modules 1 Casualties None 3 Hazardous Materials Release I Mixed Use Property H * H Not Mixed Fire-2 Deaths Injuries None NN X N Assembly use Fire 10 X Structure-3 1 Natural Gas: slow leak, no evauation or HazMat actions Education use Service 20 Civil Fire Cas.-4 2 Propane gas: <21 lb. tank (as in home BBQ grill) 33 Medical use Residential use Fire Serv. Cas.-5 Civilian 3 Gasoline: vehicle fuel tank or portable container 40 51 Row of stores EMS-6 4 Kerosene: fuel burning equipment or portable storage 2 Detector 53 Enclosed mall HazMat-7 H Diesel fuel/fuel oil:vehicle fuel tank or portable X Required for Confined Fires. 5 58 Bus. & Residential Wildland Fire-8 Household solvents: home/office spill, cleanup only Office use 1 Detector alerted occupants 6 59 X Industrial use X Apparatus-9 Motor oil: from engine or portable container 60 7 Military use Personnel-10 2 Detector did not alert them 63 X 8 Paint: from paint cans totaling < 55 gallons 65 Farm use Arson-11 Unknown Other: Special HazMat actions required or spill > 55gal., Other mixed use U 0 Please complete the HazMat form 00 J Property Use* Structures 341 Clinic,clinic type infirmary 539 Household goods,sales,repairs 342 Doctor/dentist office 579 Motor vehicle/boat sales/repair 131 Church, place of worship 361 Prison or jail, not juvenile 571 Gas or service station 161 Restaurant or cafeteria 419 1-or 2-family dwelling 599 Business office 162 Bar/Tavern or nightclub 429 Multi-family dwelling 615 Electric generating plant 213 Elementary school or kindergarten 439 Rooming/boarding house 629 Laboratory/science lab 215 High school or junior high 449 Commercial hotel or motel 700 X Manufacturing plant 241 College, adult education 459 Residential, board and care 819 Livestock/poultry storage(barn) 311 Care facility for the aged 464 Dormitory/barracks 882 Non-residential parking garage 331 Hospital 519 Food and beverage sales 891 Warehouse Outside 936 Vacant lot 981 Construction site 124 Playground or park 938 Graded/care for plot of land 984 Industrial plant yard 655 Crops or orchard 946 Lake, river, stream Lookup and enter a Property Use code only if 669 Forest (timberland) 951 Railroad right of way you have NOT checked a Property Use box: 807 Outdoor storage area 960 Other street Property Use 700 919 Dump or sanitary landfill 961 Highway/divided highway 931 Open land or field Residential street/driveway Manufacturing, processing 962 NFIRS-1 Revision 03/11/99

Plover Fire 49080 12/16/2019 19-0001731 K1 Person/Entity Involved - - Local Option Business name (if applicable) Area Code Phone Number Gerry Minton Check This Box if First Name MI Last Name same address as Mr.,Ms., Mrs. Suffix incident location. Then skip the three 8825 Central Sands RD duplicate address Number Prefix Street or Highway Street Type lines. Suffix Bancroft Post Office Box Apt./Suite/Room City WI 54921 - State Zip Code More people involved? Check this box and attach Supplemental Forms (NFIRS-1S) as necessary

2 Same as person involved? K Owner Then check this box and skip - - The rest of this section. Mongram Food Solutions Local Option Business name (if Applicable) Area Code Phone Number

Check this box if Mr.,Ms., Mrs. First Name MI Last Name Suffix same address as incident location. Then skip the three 530 Oak Court DR duplicate address Number Prefix Street or Highway Street Type Suffix lines. Memphis Post Office Box Apt./Suite/Room City TN 38117 - State Zip Code L Remarks Local Option 12/26/2019 11:28:33 Ken Voss

On 12/16/2019 at 00:11:00 Metro Fire District was dispatched and responded to 300 Moore RD /Plover, WI 54467 for the report of a Fires in structure other than in a building.

Upon arrival at 00:22:00, the following actions were performed on scene: Investigate Identify, analyze hazardous materials Remove hazardous materials Ventilate Evacuate area Notify other agencies. Extinguishment by fire service personnel

Metro Fire was requested for a commercial fire. The fire was quickly determined to be in a connected air handler near the ammonia engine room. Chief 1 elevated the alarm to a box level. The fire was extinguished after a slight delay in determining what the extent of the involvement with the ammonia area was. Once the fire was out, more monitoring was conducted by PFD and Waupaca Hazmat until the building was vented to a safe level. The area of the leak was isolated by the on site maintenance personnel.

More information can be found in the Hazmat Report narrative.

The following involvements were noted: Name/Business Name Involvement Type

L Authorization P100 Deaver, Mark R FC PRI 12 17 2019 Year Officer in charge ID Signature Position or rank Assignment Month Day

Check Box if P801 Zarecki, Brittany M AA 12 17 2019 same Position or rank Assignment Month Day Year as Officer Member making report ID Signature in charge.

Plover Fire 49080 12/16/2019 19-0001731 MM DD YYYY Complete 49080WI 12 16 2019 01 19-0001731 000 Narrative FDID **State **Incident Date Station Incident Number * Exposure

Narrative: 12/26/2019 11:28:33 Ken Voss

On 12/16/2019 at 00:11:00 Metro Fire District was dispatched and responded to 300 Moore RD /Plover, WI 54467 for the report of a Fires in structure other than in a building.

More information can be found in the Hazmat Report narrative.

The following involvements were noted: Name/Business Name Involvement Type ------Mongram Food Solutions Lutz, David

Units responding were: Unit 54C2 responded. Unit 54E1 responded. Unit 54E2 responded. Unit 54M1 responded. Unit 54R2 responded. Unit 54U1 responded. Unit 54U2 responded. Unit PRI responded.

Automatic aid Stevens Point Fire Department Hull Fire Department Waupaca County Hazmat

04:06:00 all units cleared and returned to quarters.

Plover Fire 49080 12/16/2019 19-0001731 MM DD YYYY Delete A NFIRS -2 49080WI 12 16 2019 01 19-0001731 000 X Change Fire FDID **State **Incident Date Station Incident Number * Exposure No Activity

None Complete if there were any significant B Property Details C On-Site Materials amounts of commercial,industrial, energy or agricultural products or materials on the or Products Property, whether or not they became involved Enter up to three codes. Check one or more boxes for each code entered. B1 X Not Residential 1 X Bulk storage or warehousing Estimated Number of residential living units in 541 Hazardous 2 Processing or manufacturing building of origin whether or not all units Packaged goods for sale On-site material (1) 3 became involved 4 Repair or service 1 Bulk storage or warehousing 2 X Buildings not involved 2 Processing or manufacturing B Packaged goods for sale Number of buildings involved On-site material (2) 3 4 Repair or service Bulk storage or warehousing None 1 B3 2 Processing or manufacturing Acres burned Packaged goods for sale (outside fires) Less than one acre On-site material (3) 3 4 Repair or service Cause of Ignition Human Factors Ignition E1 E3 D Check box if this is an exposure report. Contributing To Ignition Skip to section G Check all applicable boxes D1 62 Heating room or area, 1 Intentional 1 Asleep X None Area of fire origin * 2 Unintentional 2 Possibly impaired by 3 Failure of equipment or heat source alcohol or drugs 4 Act of nature 3 Unattended person D2 UU Undetermined Cause under investigation 4 Possibly mental disabled Heat source 5 X * U Cause undetermined after investigation 5 Physically Disabled Factors Contributing To Ignition 6 Multiple persons involved D3 UU Undetermined E2 Item first ignited Check Box if fire spread X None 7 Age was a factor * 1 was confined to object NN None of origin Estimated age of Factor Contributing To Ignition (1) D4 person envolved Type of material Required only if item first first ignited ignited code is 00 or <70 Factor Contributing To Ignition (2) 1 Male 2 Female

Equipment Involved In Ignition Equipment Power Fire Suppression Factors F1 F2 G None If Equipment was not involved,Skip to Enter up to three codes. Section G None Equipment Power Source Equipment Involved Equipment Portability 324 Hazardous F3 Fire suppression factor (1) Brand 1 Portable

Model 2 Stationary Fire suppression factor (2)

Portable equipment normally can be Serial # moved by one person, is designed to be use in multiple locations, and Fire suppression factor (3) Year requires no tools to install. Local Use Mobile Property Involved Mobile Property Type & Make H1 H2 Pre-Fire Plan Available None Some of the information presented in this report may be based upon reports from other Agencies 1 Not involved in ignition, but burned Mobile property type Arson report attached 2 Involved in ignition, but did not burn Police report attached 3 Involved in ignition and burned Mobile property make Coroner report attached Other reports attached

Moblie property model Year

License Plate Number State VIN Number NFIRS-2 Revision 01/19/99

Plover Fire 49080 12/16/2019 19-0001731 I1 Structure Type * I2 Building Status * I3 Building * I4 Main Floor Size NFIRS-3 If Fire was In enclosed building or a * Structure portable/mobile structure complete Height Fire the rest of this form Count the ROOF as part 1 Under construction of the highest story 1 Enclosed Building 2 X Occupied & operating 2 Portable/mobile structure 3 Idle, not routinely used 3 Open structure 001 ,,073 736 4 Under major renovation Total number of stories Total square feet 4 Air supported structure at or above grade 5 Vacant and secured 5 Tent 6 Vacant and unsecured OR 6 Open platform (e.g. piers) 7 Being demolished Total number of stories 7 Underground structure(work areas) O Other below grade , BY , 8 X Connective structure (e.g. fences) U Undetermined Lenght in feet Width in feet 0 Other type of structure

J1 Fire Origin J3 Number of Stories K Material Contributing Most * Damaged By Flame To Flame Spread Below Grade Count the ROOF as part of the highest story Check if no flame spread Skip To OR same as material first ignited Section L Story of fire origin Number of stories w/ minor damage OR unable to determine (1 to 24% flame damage) 1 J2 Fire Spread Number of stories w/ significant damage K * Item contributing most to flame spread 1 Confined to object of origin (25 to 49% flame damage) 2 Confined to room of origin Number of stories w/ heavy damage K2 Confined to floor of origin (50 to 74% flame damage) 3 Type of material contributing Required only if item 4 Confined to building of origin most of flame spread contributing Number of stories w/ extreme damage code is 00 or<70 5 Beyond building of origin (75 to 100% flame damage) L1 Presence of Detectors * L3 Detector Power Supply L5 Detector Effectiveness (In area of the fire) Required if detector operated Skip to 1 Battery only N None Present section M 2 Hardwire only 1 Alerted Occupants, occupants responded 1 X Present 3 Plug in 2 Occupants failed to respond 4 Hardwire with battery 3 There were no occupants Undetermined U 5 Plug in with battery 4 Failed to alert occupants 6 Mechanical U Undetermined L2 Detector Type 7 Multple detectors & power supplies L6 Detector Failure Reason 1 Smoke 0 Other Required if detector failed to operate 2 Heat UXUndetermined 1 Power failure, shutoff or disconnect Combination smoke - heat 3 L4 Detector Operation 2 Improper installation or placement 4XSprinkler, water flow detection 1 Fire too small 3 Defective to activate 4 Lack of maintenance, includes cleaning 5 More than 1 type present 2 Operated 5 Battery missing or disconnected (Complete Section L5) Battery discharged or dead O Other 6 3 Failed to Operate Other (Complete Section L6) 0 U Undetermined Undetermined UXUndetermined U

M1 Presence of Automatic Extinguishment System * M3 Automatic Extinguishment M5 Automatic Extinguishment System Operation System Failure Reason None Present N Required if fire was within designed range Complete rest Required if system failed 1 X Present 1 Operated & effective (Go to M4) of Section M 1 System shut off 2 Operated & not effective (M4) M2 Type of Automatic Extinguishment System 2 Not enough agent discharged * 3 Fire too small to activate Required if fire was within designed range of AES Agent discharged but did 4 Failed to operate (Go to M5) 3 1 X Wet pipe sprinkler not reach fire 0 Other 2 Dry pipe sprinkler 4 Wrong type of system U Undetermined 3 Other sprinkler system 5 Fire not in area protected 4 Dry chemical system 6 System components damaged M4 Number of Sprinkler 5 Foam system Heads Operating 7 Lack of maintenance 6 Halogen type system Manual Intervention Required if system operated 8 7 Carbon dioxide (CO 2) system 0 Other 0 Other special hazard system U Undetermined U Undetermined Number of sprinkler heads operating NFIRS-3 Revision 01/19/99

Plover Fire 49080 12/16/2019 19-0001731 MM DD YYYY A NFIRS - 7 49080WI 12 16 2019 01 19-0001731 000 1 Delete HazMat FDID **State **Incident Date Station Incident Number * Exposure Haz No * X Change B HazMat ID Chemical * Ammonia 1005 7664-41-7 Name UN Number DOT Hazard CAS Registration Number Classification Physical State C1 Container Type Estimated Container Capacity E1 C2 D1 Estimated Amount Released When Released ,, ,, 1 1 Solid 22 Capacity: by volume or weight Amount released: by volume or weight 2 Liquid Container Type 3 Gas C3 Units: Capacity U Undetermined Check one box D2 Units: Released Check one box VOLUME WEIGHT VOLUME WEIGHT 11 Ounces 21 Ounces 11 Ounces 21 Ounces E2 Released Into More hazardous 12 Gallons 22 Pounds 12 Gallons 22 X Pounds Materials? Use 13 Barrels: 42 gal. 23 Grams 13 Barrels: 42 gal. 23 Grams additional sheets. 14 Liters 24 Kilograms 14 Liters 24 Kilograms 1 15 Cubic feet 15 Cubic feet Released into 16 Cubic meters 16 Cubic meters

F2 Population Density G2 Area Evacuated None H HazMat Actions Taken Complete the remainder Enter up to three actions taken of this form only for the first hazardous material 1 Urban 1 Square Feet 8 , 999 HazMat detection, involved in this incident. X 12 2 Suburban Blocks Enter Primary Action Taken (1) 2 Measurement 3 X Rural 3 Square miles 14 HazMat leak control Estimated Number of F1 Released From: G3 Additional Action Taken (2) G1 Area Affected People Evacuated Check all applicable boxes 24 Provide equipment , Additional Action Taken (3) Below grade 1 X Square Feet 2 Blocks If fire or explosion is involved with a 1 Inside/on structure Estimated Number of I release, which occurred first? 3 Square miles G4 Story of Buildings Evacuated 1 X Ignition U Undetermined Release 8 999 1 None Outside of structure , , 2 Release 2 X Enter Measurement J Cause Of Release * K Factors Contributing to Release L Factors Affecting Mitigation Enter up to three contributing factors Enter up to three factors or impediments that 1 Intentional affected the mitigation of the incident 2 Unintentional release

3 X Container/ Factor Contributing To Release (1) Factor or impediment (1) containment failure 4 Act of nature 5 Cause under investigation Factor Contributing To Release (2) Factor or impediment (2) U Cause undetermined after investigation Factor Contributing To Release (3) Factor or impediment (3) HazMat Disposition M Equipment Involved In Release N Mobile Property Involved None O * In Release 1 Completed by fire service only None 2 X Completed w/ fire service present Mobile property type Equipment involved in release 3 Released to local agency 4 Released to county agency Mobile property make 5 Released to state agency Brand 6 Released to federal agency 7 Released to a private agency Model Mobile property model Year 8 Released to property owner or manager Serial License Plate Number State HazMat Civilian Casualties Number O Year Deaths Injuries DOT Number/ ICC Number

NFIRS-7 Revision 5/6/99 Plover Fire 49080 12/16/2019 19-0001731 MM DD YYYY Hazmat WI 01 49080 12 16 2019 19-0001731 0 Narrative FDID **State **Incident Date Station Incident Number * Exposure Hazardous Materials Narrative: 12/26/2019 11:19:32 Ken Voss

Plover Fire Department was dispatched and responded to the report of a fire in an air handling unit at 300 Moore Rd, Monogram Foods. Upon arrival, Chief 1 assumed command and established a safe zone upwind of the structure. There is an ammonia engine room adjacent to where the fire was on the east side of the building. The employees were all evacuated to the west. Engine 2 was assigned to move in and monitor the area for ammonia and extinguish the fire.

There were initially 200 ppm of ammonia inside the door due to ammonia lines that were running to the exchanger. THe building was checked over by Hull and other PFD units. A command post was established on the SW side of the building. Waupaca Hazmat was notified and Portage County Emergency Management was also notified at this time. Constant updates were given to both Waupaca and PCEM.

Monogram maintenance and Summit (their ammonia system contractor) were also on scene working to mitigate the situation. It was determined that the leak was not large so minimal evacuation was needed. the Maintenance crew was able to isolate the area that was leaking. Waupaca arrived on scene and they worked with units on scene to monitor all the interior of the building. The air exchanger in the building was used to ventilate the areas that had higher readings. Once the building was clear, all units were released and the building was turned over to Monogram Foods.

Plover Fire 49080 12/16/2019 19-0001731 A MM DD YYYY NFIRS - 9 49080WI 12 16 2019 01 19-0001731 000 Delete Apparatus or FDID **State **Incident Date Station Incident Number * Exposure X Change Resources B Apparatus or * Date and Times Sent Number Use Actions Taken Check ONE box for each Resource Check if same as alarm date of * apparatus to indicate X its main use at the Month Day Year Hour Min People incident. Dispatch 1 ID 54C2 X 12 16 2019 00:11 X Suppression Arrival X 12 16 2019 00:22 X 1 EMS Type 921 Clear X 12 16 2019 04:06 Other Dispatch 2 ID 54E1 X 12 16 2019 00:11 X Suppression Arrival X 12 16 2019 00:22 X 3 EMS Type 11 Clear X 12 16 2019 04:06 Other Dispatch 3 ID 54E2 X 12 16 2019 00:11 X Suppression Arrival X 12 16 2019 00:22 X 5 EMS Type 11 Clear X 12 16 2019 04:06 Other Dispatch 4 ID 54M1 X 12 16 2019 00:11 X Suppression Arrival X 12 16 2019 00:22 X 2 EMS Type 76 Clear X 12 16 2019 04:06 Other Dispatch 5 ID 54R2 X 12 16 2019 00:11 X Suppression Arrival X 12 16 2019 00:22 X 1 EMS Type 71 Clear X 12 16 2019 04:06 Other Dispatch 6 ID 54U1 X 12 16 2019 00:11 X Suppression Arrival X 12 16 2019 00:22 X 3 EMS Type 91 Clear X 12 16 2019 04:06 Other Dispatch 7 ID 54U2 X 12 16 2019 00:11 X Suppression Arrival X 12 16 2019 00:22 X 2 EMS Type 60 Clear X 12 16 2019 04:06 Other Dispatch 8 ID PRI X 12 16 2019 00:13 X Suppression Arrival X 12 16 2019 00:22 X 1 EMS Type 99 Clear X 12 16 2019 04:06 Other Dispatch 9 ID Suppression Arrival EMS Type Clear Other Type of Apparatus or Resources Ground Fire Suppression Marine Equipment More Apparatus? 11 Engine 51 Fire boat with pump 12 Truck or aerial Use Additional 52 Boat, no pump 13 Quint Sheets 50 Marine apparatus, other 14 Tanker & pumper combination Support Equipment 16 Brush truck Other 17 ARF (Aircraft Rescue and Firefighting) 61 Breathing apparatus support 91 Mobile command post 10 Ground fire suppression, other 62 Light and air unit 92 Chief officer car 60 Support apparatus, other Heavy Ground Equipment 93 HazMat unit 21 Dozer or plow Medical & Rescue 94 Type 1 hand crew 22 Tractor 71 Rescue unit 95 Type 2 hand crew 24 Tanker or tender 72 Urban Search & rescue unit 99 Privately owned vehicle 20 Heavy equipment, other 73 High angle rescue unit 00 Other apparatus/resource Aircraft 75 BLS unit 41 Aircraft: fixed wing tanker 76 ALS unit NN None UU Undetermined 42 Helitanker 70 Medical and rescue unit,other 43 Helicopter 40 Aircraft, other NFIRS-9 Revision 11/17/98

Plover Fire 49080 12/16/2019 19-0001731 MM DD A YYYY NFIRS - 10 Delete 49080WI 12 16 2019 01 19-0001731 000 Personnel FDID **State **Incident Date Station Incident Number * Exposure X Change B Apparatus or * Date and Times Sent Number Use Actions Taken Resource Check if same as alarm date of Check ONE box for each List up to 4 actions X * apparatus to indicate for each apparatus People its main use at the and each personnel. Use codes listed below Month Day Year Hours/mins incident. Dispatch 1 ID 54C2 X 12 16 2019 00:11 Sent X Suppression Arrival X 12 16 2019 00:22 1 EMS Type X 921 Clear X 12 16 2019 04:06 Other