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_ 4F Actions Taken G1 Resources G2 <br /> r Apparatus or Personnel Modete is used. Estimated Dollar Losses and Values <br /> 11-Extinguishment by fire service Apparatus parsoesei <br /> personnel <br /> non-firLosses: ReGwred for all Fires if None <br /> Suppression 6 I 16 I l:rfnir.es.Optio.ra!for ah <br /> Primary Action Taken <br /> 12-Salvage&overhaul ( EMS 11 112 I Property:$I 40,000.00 I r <br /> Avditiona;Arbor Takao Other 10 I I 0 I , Contents:$I 10,000.00 I r <br /> FResource counts include aid receir;ed Pre-Incident Values:Optional None <br /> resources. <br /> Property:$145,000.00 r <br /> Contents:$I 20,000.00 I r <br /> Completed Modules Hi Casualties rNone H3 <br /> r 2-Fire l Mixed Use Property <br /> Deaths Injuries Hazardous Materials Release +f Not Mixed <br /> r 3-Structure Fire I r 1-Natural Gas r 10-Assembly Use <br /> r 3-Civilian Are Cas. Fire u r 2-Propane Gas r 20-Education Use <br /> r 5-Fire Service Cas. Service r 3-Gasoline r 33-Medical Use <br /> r 6-EMS Civilian o 0 r 4-Kerosene <br /> r S-Diesel Fuel/ Oil r 40-Residential Use <br /> r 7-HazMat r 51-Row Of Stores <br /> r 8-Wildland Fire r 6-Household Solvents r 53-Enclosed Mall <br /> r 9-Apparatus r 7-Motor Oil r 58-Business and <br /> r 10-Personnel r 8-Paint Residential <br /> r 11-Arson H2 Detector r 0-Other r 59-Office Use <br /> Required for Confined fires P None r 60-Industria(Use <br /> r 1-Detector Alerted Occupants r 63-Military Use <br /> F7 2-Detector Did Not Alert Them r 65-Farm Use <br /> r 3-Unknown r 00-Other Mixed Use <br /> J Property Use rNone 341 r Clinic,Clinic-Type Infirmary 539r Household Goods,Sales,Repairs <br /> Structures 342 r Doctor/Dentist Office 571r Gas or Service Station <br /> 131r Church,Place of Worship 361r Prison or Jail,Not Juvenile 579r Motor Vehicle/Boat Sales/Repairs <br /> 161 r Restaurant or Cafeteria 419F7 1-or 2-Family Dwelling 599r Business Office <br /> 162 r Bar/Tavern or Nightclub 429r MultiFamily Dwelling 615 r Electric-Generating Plant <br /> 213r Elementary School,Kindegarten 439r Rooming/Boarding House 629 r Laboratory/Science Laboratory <br /> 215r High School,Junior High 449r Commerical Hotel or Motel 700r Manufacturing Plant <br /> 241 r College,Adult Education 459r Residential,Board and Care 819r Livestock/Poultry Storage(Barn) <br /> 311 r Nursing Home 464r Dormitory/Barracks <br /> 331 r Hospital ry/ 891 r sidential Parking Garage <br /> 519r Food and Beverage Sates 891 r Warehouse <br /> Outside 938r Graded/Cared for Plot of Land Property Use: <br /> 124r Playground or Park 946r Lake,River,Stream <br /> 655r Crops or Orchard 951 r Railroad Right-of-Way I I <br /> 669r Forest(Timberland) 960r Other Street <br /> 807r Outdoor Storage Area 961r Highway/Divided Highway Description <br /> 919r Dump or Sanitary Landfill 962r Residential Street/Driveway Loot up and enter a Property Use code and <br /> 931 r Open Land or Field 981 r Construction Site description only if you have NOT checked a <br /> 936r Vacant Lot 984r Industrial Plant Yard Property Use box. <br /> K1 <br /> Person/Entity Involved I Occupant I I <br /> 1 II 6052225928 <br /> Local Option, Person/Entity Type Business Name(if ai;plicabte) Phone Number <br /> I I I Jennifer I I 11 Farrell I I I <br /> Mr.,his..Mrs. First Name MI <br /> Last Name Suffix <br /> 15076 H I I I Copper Creek Loop NE 11 II I <br /> Number Prefix Street or Highway Street Type Suffix <br /> II I I I Salem <br /> Post Office Box Apt./Suite/Room ' City <br /> IOR I 197305 I <br /> State <br /> lip Code <br />