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NUMBER OF UNITS ON SCENE <br />Aerial Apparatus / <br />Squad Truck(s) <br />Engine(s) / Brush Truck(s) _ <br />Tanker(s) -? _ A-1 Ambulance <br />Inventory Complete on all Fire Apparatus _l."es No <br />Missing/Damaged Equipment / A.rk <br />Number of Firefighter= on Scene = Number of Firefighters on Standby <br />Mutual Aid Yes . No Department(s) <br />EMS INFORMATION (Check here if not applicable 4 <br />Number of Patients Transported <br />Emergency <br />A-1 Unit <br />Non -Emergency <br />Nc Transport <br />TO: <br />Initial 7 ) <br />Avista Hospital <br />Boulder Community Hospital <br />S. Anthony's North Hospital <br />St. Anthony's Central Hospital <br />Other <br />FIRE INFORMATION <br />(Check here if not applicable Initial <br />SUPPRESSION EXTENT OF DAMAGE <br />J <br />Structure <br />Area of Origin <br />Type <br />Method of Extinguishment <br />By Flame: <br />By Smoke: <br />By Water: <br />_ rated Dol' =r ' cs <br />Est <br />HOSE USED (FT) EQUIPMENT <br />Booster `_ne _ `2" P___ Packs l5/ <br />;: 7,r /"r) Generators _3 <br />Telesquir: Boon Yes _ No Salvage e -veers ") <br />s'S Do <br />USED (#'S) <br />Fans <br />Ladders <br />drant- <br />Remarks. <br />✓L-0 f <br />�.ii /.O /__^%c • ✓ ✓�-o-'r <br />)' 3. ,_,_ , y. <br />i....,....- .,..,. a..a...,... <br />.IwVoW SFr. r....�.Fi <br />S..-;.w.•.. • W <br />Print Name/Rank of Officer In Charge <br />rv•r.a.gaIN' <br />.r.....a....•— ........_..r <br />Print Name/Rank of Reporting F.F. <br />/://z <br />// Sign- re Dade <br />Signature <br />Date <br />