HomeMy WebLinkAboutHAZMAT 88-0494 - 215 ANDOVER PARK WEST - CHEMICAL SPILL OR LEAK ON 3/29/1988215 ANDOVER PARK
WEST
CHEMICAL SPILL OR LEAK
HAZMAT # 88-0494
FIRESTONE
WASHINGTON STATE FIRE INCIDENT REPORT
FIRE D EPPT,.
NFIRS 1
1 ❑ delete
2 ❑ change
10
FDID
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' I f /III
INCIDENT NO. EXP. MO. DAY
/
/l40,1-igkocoi2g
YEAR
g
DAY OF WEEK
5 0 Thursday
1 0 Sunday3 0 Tuesday6 ❑friday/j
2 ❑ Monda4 ❑ Wednesay 7 Saturday
/
ALARM TIME
/ 4 250
ARRIVAL TIME
/Ai
TIME IN SERVICE
A7,3q
B
C‘tleCre/
D
TYPE OF SITUATION FOUND
1. FIRE, EXPL. I 3. RESCUE I
1 ' S•. SER. CALL , • I
1
7. FALSE I 1 I
2. PRESSURE RUPTURE 1 I I 4. HAZ. COND. I I I 6. GOOD INTENT
9. OTHER. 1 1 I
ACTION
TAKEN
1 ❑ Extinguishment 5 0 Stand by 8 0 Fill in. Move up
escue Only 6 ❑Selvage 9 0 Not classified
3 Investigation only 7 0 Emerg. Med. 0 E Undetermined/Not reported
❑ Remove Hazard
OTHER '
MU AL AID
1 0 Rec'd
2 fa Given
, j N/A
LEVEL OF FIRE ORIGIN
1 0 Grade level to 9 ft. 6 0 Over 70 feet
2 0 10 to 19 feet 7 0 Objects in flight
3 0 20 to 29 feet 8 0 Below ground level
4 0 30 to 49 feet 9 0 Not classified above
5 50 to 70 feet' 0 Undetermined`
FIXED PROPERTY USE (Occupancy)
.
IGNITION FA TOR
CORRr'CT ADDRESS (Up to maximum of 21 characters)
69/5 iadtt)V&r tOeit ,--
ZIP CODE
_liaile8
CENSUS TRACT
00012i&I;-?
11
OCCUPANT NAME (LAST, FIRST, M.I.)
g-ke--5-aide
TELEPHONE
we/kaki
ROOM or APT.
we,
OWNER NAME
%/ r (LAST, FIRST, MI)
D i
ADDRESS
/%/fir% r , /
TELEEPPHHONEE12 j, d
,3
METHOD OF ALARM
14 Telephone direct 4 0 Radio 8 0 Voice signal municipal alarm signal
2 Municipal alarm system 5 0 Verbal 9 0 Not terminad
3 0 Private alarm system' 6 ❑,No alarm recd. 0 ❑Undetermined or, not reported
7 0 Tie -line (911)
/
CO. INSPECTION
DISTRICT I
' I
SHIFT
i
A
NO. ALARMS
1/
H
NO. FIRE SERVICE PERSONNEL
RESPONDED
{ 10166
NO. ENGINES
RESPONDED
DI I
NO. AERIAL APPARATUS I
RESPONDED
(J
NO. OTHER VEHICLES 4
/ RESPONDED
ISI oI
J
K
L
M
M
0
4
R
COMPLEX
NUMBER OF INJURIES Complete Form NFIRS 3
i COMPLETE FORM
NFIRS 2
NUMBER OF FATALITIES
'
I
EQUIPMENT INVOLVED IN IGNITION (Complete Line T)
I
20
FIRE SERVICE D
OTHER
FORM OF MATERIAL IGNITED
FIRE SERVICE
4
y
1
OTHER '
J
K
L
M
M
0
4
R
COMPLEX
I
MOBILE PROPERTY TYPE (Complete Line S)
•
1
MODEL
AREA OF FIRE ORIGIN
I
EQUIPMENT INVOLVED IN IGNITION (Complete Line T)
I
YEAR
FORM OF HEAT IGNITION f
ti
I
TYPE OF MATERIAL IGNITED
1
FORM OF MATERIAL IGNITED
1
4
y
METHOD OF
EXTINGUISHMENT 2 0 Make 3 0 Portable lexti extinguisher 6 0 Pre -connect hose/hydrant ft aids 5 0 Pre -connect hose/tank Master dvice
draft standpipe 9 0 Not classified
0 1 Self extinguished 4 0 Automatic ext. •system 7 0 Hand -laid hose/hydrant draft standpipe 0 0 Undetermined or not reported
LEVEL OF FIRE ORIGIN
1 0 Grade level to 9 ft. 6 0 Over 70 feet
2 0 10 to 19 feet 7 0 Objects in flight
3 0 20 to 29 feet 8 0 Below ground level
4 0 30 to 49 feet 9 0 Not classified above
5 50 to 70 feet' 0 Undetermined`
ESTIMATED DOLLAR LOSS
I 1 1 11 1 1 I I
NUMBER OF STORIES
1 1 story. 4 5 to 6 stories.
2 0 2 story. 5 0 7 to 12 stories.
3 0 3 to 4 stories. 6 0 13 to 24 stories.
•
7 0 25 to 49 stories.
8 0 50 stories or more.
0 0 Number of Stories undetermined or not reported.
CONSTRUCTION TYPE
1 0 Fire resistive
2 0 Heavy timber
3 0 Protected noncombustible
4 0 Unprotected noncombustible
5 0 Protected ordinary
6 0 Unprotected ordinary
7 0 Protected wood frame
8 0 Unprotected wood frame
9 0 Not classified above
0 0 Undetermined or not
reported
EXTENT OF DAMAGE
Flame
1 Confined to the object of origin 1 0
2 Confined to part of room or area of origin 2 0
3 Confined to room of origin 3 0
4 Confined to the fire -rated comp. of origin 4 0
5 Confined to floor of origin 5 0
6 Confined to structure of origin 6 0
7 Extended beyond structure of origin 7 0
0 Undetermined/not reported 0 0
9 No damage of this type (N/A)
Smoke
1 ❑
3
4 ❑
5
6
7
0
9
P
DETECTOR PERFORMANCE
1 0 Det. in room or space of fire origin-oper.
2 0 Det. not in rm. or space of fire origin-oper.
3 0 Det in rm. or space of origin -not oper.
4 0 Det. not in rm. or space of origin -not oper.
5 0 Det. not in rm. or space of fire origin
but fire too small to oper.
8 0 No detectors present
9 0 Not classified
0 0 Undetermined or not reported
SPRINKLER PERFORMANCE
1 0 Equipment operated
2 0 Equipment should have operated—did not
3 0 Equipment present, fire too small to oper.
8 0 No equipment present (N/A)
9 0 Not classified
0 0 Undetermined or not reported
TYPE OF MATERIAL GENERATING MOST SMOKE
IF SMOKE SPREAD
BEYOND ROOM
OF ORIGIN
FORM OF MATERIAL GENERATING MOST SMOKE
1
AVENUE OF SMOKE TRAVEL
1 0 Air handling duct
2 0 Corridor
3 0 Elevator shaft
4 0 Stairwell
5 0 Opening in construction
6 0 Utility opening in wall
7 0 Utility opening in floor
8 0 No avenue of smoke travel
9 0 Not classified
0 0 Undetermined or not reported
n
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30
IF MOBILE PROPERTY
(N.A. IF NOT APPLICABLE) iti
YEAR
MAKE
MODEL
SERIAL NO.
LICENSE NO.
40
IF EQUIPMENT (N.A. IF NOTPPLICABLE)
INVOLVED y r• ,/I•
IN IGNITION . ,A` f/ TJ/.J
YEAR
MAKE
MODEL
SERIAL NO.
u
OFFICER
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INCIDENT* 459
03292 17§0:28 SAT MAR 19G988
215 ANDOVER PARKW
DISPATCHED R:N»ae£I
RP:
998
R3 R:
29 R:
RUN* : gm
MAP @4: Sm
FDZ @
2&: 52;9
T7wa
ON -LOC 11±2 RETURN 'RETURN egg RIOT§ m-59
@e. S3. RESPOND S S 5 3 5
19 g
_H52 . !1639:01 !
!1642:58 !
§2@e'
913 11257 1163503 g63E71
§63934
_52 . 1163A:3P
162:2 1 11651:55
1155#!
RUN CARD COMMENTS: SHEP IMMED 22222 MEDIC 4/5
APPARATUS:
A = A51 e! E52 A53 E«
E = e! 952 913 23 E76 E42 7741 EB 971
L = g! 151 g! L2
169:2 CODE GREENED ALL UNITS
9N
4 42 Cou'
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