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HomeMy WebLinkAboutWATERLOO FIRE RESCUE - FEMA PROJECT WORKSHEET AND DOCUMENTATION FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B.No.3067-0151 PROJECT WORKSHEET Expires April 30,2001 PAPERWORK BURDEN DISCLOSURE NOTICE Public reporting burden for this form is estimated to average 30 minutes. The burden estimate includes time for reviewing instructions,searching existing data sources,gathering and maintaining the needed data,and completing and submitting the forms. You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of the forms. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing the burden to:Information Collections Management,Federal Emergency Management Agency,500 C Street,SW,Washington DC,20472, Paperwork Reduction Project(3067-0151). NOTE: Do not send your completed form to this address. DECLARATION NO. PROJECT NO. I FIPS NO. DATE CATEGORY FEMA- 1688 -DR- IA 1688 013-82425-00 March 26, 2007 B DAMAGED FACILITY WORK COMPLETE AS OF: March 2, 2007 100 APPLICANT COUNTY City of Waterloo Black Hawk LOCATION LATITUDE I LONGITUDE Throughout the City of Waterloo DAMAGE DESCRIPTION AND DIMENSIONS Rsponded to over 60 storm related calls for service. These calls included a residential house fire. Most of the calls included downed electrical wires, electrical problems, and fire alarms. 6 SCOPE OF WORK Responded to over 60 storm related calls.The scope of work included fire suppression, fire investigation, hazard removal, and community protection. Does the Scope of Work change the pre-disaster condition at the site? ❑ Yes ❑� No Special Considerations issues included? ❑Yes 0 No Hazard Mitigation proposal included? ❑ Yes ❑ No Is there insureance coverage on this facility? Yes El No PROJECT COST ITEM CODE NARRATIVE QUANTITY / UNIT UNIT PRICE COST Fire 8691 Storm related response calls 1250 gpm / hour $56.00 $276.00 Fire 8692 Storm related response calls 1500 gpm / hour $71.00 $1,219.00 s7 C = A,. ^ ' , g �y. P � i 1i a 64 F16 r k k4kk „, 'V , k TOTAL COST $ 1,495.00 PREPARED BY: Ned DeBerg TITLE: Fire Chief FEMA Form 90-91,SEP 98 REPLACES ALL PREVIOUS EDITIONS A MM DD yyyy ❑Delete NFIRs -1 107039 I I A 1 02 I 1 231 I 2007 I 11 1 107-0017973 I 1 000 I ❑Change Basic FDID * State* Incident Date * Station Incident Number * Exposure ❑No Activity 'paw°" Census Tract 10005 1-1 0 0 1 U Location*B Modu"lelter tion"l In Section H°Anativ `Lo ecation'Speoifica ; only for wildland %'.-:1e1U rite ®Street address 1 008001 1w 1 [PARKER �� I 1ST 1 L-_J ❑Intersection Number/Milepost Prefix Street or Highway Street Type Suffix ['In front of I I 'WATERLOO 1 'IA 1 150703 1-[ _] ®Rear of Apt./Suite/Room City State zip Code ['Adjacent to ❑Directions 1 Cross street or directions, as applicable Secondary Address Midnight is 0000 Shift & Alarill$ C Incident Type * El Date & Times E2 Check boxes if Local Option 1 740 I 'Unintentional transmission of 1 Month Day Year Hr Min Sec dates are the Incident Type same as Alarm ALARM always required 1B I 1 011 -- Date. Alarm * I o21 231 1 20071121:07:13 1 '. Aid. Given or Received* Shift or Alarms District D Platoon ARRIVAL required, unless canceled or did not arrive 1 ❑Mutual aid received ® Arrival * 1 021 1 231 L 2007112i:22:o° 1 -3 2 ❑Automatic aid recv. Their FDID Their State CONTROLLED Optional, Except for wildland fires Special Studies) 3 ®Mutual aid given 4 ❑Automatic aid given I I ®Controlled 1 021 1 231 L 20071121:30:00 1 Local Option 5 ❑Other aid given Their LAST UNIT CLEARED, required except for wildland fires 1 I L__ IncidentNumber Last Unit Special Special N ®None III I 021 I 231 L 20071121:30:00 1 study IDq Study Value Cleared F Actions Taken * Gl Resources * G2 Estimated Dollar Losses & Values N1 Check this box and skip this LOSSES: Required for all fires if known. Optional 111 section if an Apparatus or Personnel form is used. for non fires. None 186 1 'Investigate Apparatus Personnel Property $1 1 , 1 000l ,1 0001 ❑ Primary Action Taken (1) Suppression I I Contents $I 1 , 1 o001,1 oo J I I I ' Additional Action Taken (2) EMS ' I i I PRE-INCIDENT VALUE: optional I I L_____ I other ' 0 00 11 I 00041 Property $I 1 , 1 0001 ,1 002" ❑ Additional Action Taken (3) ❑ Check box if resource counts include aid received resources. Contents $I I , I 0001 ,1 00p] ❑ Completed Modules Il1*Casualties0zone H3 Hazardous Materials Release I Mixed Use Property NNNot ❑Fire-2 Deaths Injuries N E None 10 3C Ass Mixed 3. Assembly use Structure-3 Fire 1 Natural Gas: slow leak, no e�oestiec or Ha:Mat actions Service I 11 I ❑ 20 ®Education use ® ['Civil Fire Cas.-4 2 ❑Propane gas: <21 lb. tank (as in home ssq grill) 33 Medical use ❑Fire Serv. Cas.-5 Gasoline: vehicle fuel tank o 40 ®Residential use Civilian) J I 13 ❑ r portable container ❑EMS-6 4 ❑Kerosene: fuel burning51 �.Row of stores H2 Detector equipment or portable storage 53 —Enclosed mall 0HaZMat-7 Required for Confined Fires. 5 ❑Diesel fuel/fuel oil:vehicle fuel tank or portable 58 Bus. & Residential ❑Wildland Fire-8 6 ❑Household solvents: home/office Spill, cleanup only 59use —Office 1❑Detector alerted occupants ®Apparatus-9 7 ❑Motor oil: from engine or portable container 60 Industrial use ®Personnel-10 20Detector did not alert them 8 ❑Paint: from paint cans totaling< !is gallons 65 ®Farmtar use use 111Arran-11 L 0 Unknown 0 ❑Other: Special HazMat actions required or spill o ssgal., 00 —Other mixed use Please complete the HazMat form — _ 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 3 6 1❑Prison or jail, not juvenile 571 ❑Gas or service station 161 ['Restaurant or cafeteria 4 19❑ 1-or 2-family dwelling 599 D 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 Manufacturing plant 241 ❑College, adult education 459❑Residential, board and care 819 ❑Livestock/poultry storage(barn) 3 13, ['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 669 ❑Forest (timberland) 951 ['Railroad right of wayLookup and enter a Property Use code only if g you have NOT checked a Property Use box: 807 ['Outdoor storage area 960 ['Other street Property Use 1700 1 919 ❑Dump or sanitary landfill 961 ❑Highway/divided highway 931 ❑Open land or field 962 ['Residential street/driveway 'Manufacturing, processing NFIRS-1 Revision 06/03/05 FIRE RESCUE 07009 02/23/2007 07-0017973 1(1 Person/Entity Involved (Weyerhaeuser I 1319 I - I234 I-I1753 I Local Option Business name (if applicable) Area Code Phone Number I I IMaike 19 .1 'Santiago I L__J Check This Box if Mr.,Ms., Mrs. First Name MI Last Name Suffix same address as 11 incident location.Then skip the three 100800 I 1W I I PARKER I I S T I U duplicate address Number Prefix Street or Highway Street Type Suffix lines. I I I I (WATERLOO Post Office Box Apt./Suite/Room City I IIA II50703 I-I I State zip Code []More people involved? Check this box and attach Supplemental Forms (NFIRS-1S) as necessary K2Yy Owner 0 Same as person involved? Then check this box and skip I i L I - L I I The rest of this section. Local Option Business name (if Applicable) Area Code Phone Number f I I I II II 1 L_____J Check this box if Mr.,Ms., Mrs. First Name MI Last Name Suffix 1 same address as I I I I ( �,—aJ I I Liincident location. j Then skip the three ! duplicate address Number Prefix Street or Highway Street Type Suffix lines. I I l I I Post Office Box Apt./Suite/Room City I II I-I__ State zip Code ..._.__,__.._......_..__._. I, 'L Remarks Local Option Rescue Engine 301 responded to a Notifier Trouble Alarm at Weyerhaeuser, 800 W. Parker. On arrival, there was nothing showing. We found maintenance, and they reset the alarm. This alarm was probably set off by the lightning storm. 10-8 ® 2130 (I 1 !t L Authorization IMCGRANE,A I IMcGrane, Anthony I ILT I I ___I L 021 I 231 I 20071 Officer in charge ID Signature Position or rank Assignment Month Day Year Check ® I MCGRANE,A I I McGrane, Anthony I ILT I I I I 0 2 I L 2 3I I 20071 same Position or rank Assignment Month Day Year as Officer Member making report ID Signature in charge. FIRE RESCUE 07009 02/23/2007 07-0017973 A MM DD YYYY ❑Delete 107009 I 'IA 1 I 02 1 1231 I 2007 1 11 I 107-0017976 1 1 0001 NF1as -1 FDID State Incident Date ❑Change Basic iv1, Station Incident Number * Exposure ic ❑No Activity B e d e , iLu,a oe'. e s y ,,,eu ui. o„ ires. u r,=e Census Tract 0001 —1©0_I Location* Uaroame�ln�secaon B^Al ternacive LLoca[ionespeci Fication".UUse only [or wilalanaeii red. ®Street address 1 1 006101 1E 114TH (m',J 1 I ST I L.J ❑Intersection Number/Milepost Prefix P Street or Highway Street Type Suffix ['In front of DRear of I 1 'WATERLOO I IIA I L50703 I-l_____.1 Alt./Suite/Room City State Zip Code ❑Adjacent to ❑Directions Cross street or directions, as applicable I 10 4 I r" Secondary Address Incident Type * Midnight is 0000 El Date & Times E2 Shift & Alarms 1740 I 'unintentional transmission of 1 Check boxes if MonthLocal Option I Incident Type dates are the Day Year Hr Min Sec same as Alarm ALARM always required D Aid Given or Received* Date. Alarm * 1 021 I 231 I 20071121:08:00 1 IE 1 I 011 �' Shift or Alarms District Platoon ARRIVAL required, unless canceled or did not arrive 1 ❑Mutual aid received Il 1 ® Arrival * 1 021 1 2311 20071121:23:00 I E3 2 ❑Automatic aid recv. Their FDID Their State CONTROLLED O 3 ['Mutual aid given ptional, Except for wildland fires Special Stud`lest 4 []Automatic aid given I I ®Controlled 1 021 1 231 1 20071121:30:00 I Local Option 5 ❑Other aid given Their LAST UNIT CLEARED, required except for wildland fires Incident Number Last Unit 1 1 N v None Special Special ® Cleared 1 021 I 231 ( 20071121:30:00 I Study um Study Value F Actions Taken * G1 Resources * G2 Estimated Dollar Losses & Values n Check this box and skip this I= section if an Apparatus or LOSSES: Required for all fires if known. Optional 86 I 'investigateI Personnel form is used. for non fires. None Apparatus Personnel Property $1 1 , 1 0001,1 000_1 ❑ Primary Action Taken (1) Suppression 1 I I I Contents $1 1 , 1 0001,1 000I ❑ I I I --J EMS 1 I I Additional Action Taken (2) PRE-INCIDENT VALUE: Optional 1 11 1 Other 1 00011 1 00021 Property $1 1 , 1 0001 ,1 0001 ❑ Additional Action Taken (3) ❑ Check box if resource counts (9� include aid received resources. Contents $1 I , 1 0001,I 00J ❑ Completed Modules Hl*Casualties❑None H3 Hazardous Materials Release I Mixed Use Property ❑Fire-2 Deaths Injuries N FiNone NN X Not Mixed Structure-3 Fire 10 Assembly use ❑ I I I I 1 ['Natural Gas: slow leak, no evanation or Ha=neat actions 20 Education use Fire Cas.- Service I r� ['Civil 2 L Propane gas: <21 lb. tank las in home sHn grill) 33 Medical use ['Fire Serv. Cas.-5 Civilian' i I I 3 ❑Gasoline: vehicle fuel tank or portable container 40 ®Residential use ❑EMS-6 4 0Kerosene: fuel burning equipment or portable storage 51 —Row of stores ❑HazMat-7 Detector 53 —Enclosed mall Required for Confined Fires. 5 C]Diesel fuel/fuel oil:vehicle fuel tank or portable 58 "'Bus. & Residential 0 Wildland Fire-8 6 ��Household solvents: homeioffice spill, cleanup only 59 ®Office use 1❑Detector alerted occupants g Apparatus-9 7 Motor oil: from engine or60 _ ❑ _Office use e g portable container ®Personnel-10 20Detector did not alert them 8 63 Military use C]Paint: from paint cans totaling c 55 gallons 65 —Farm use ❑Arson-11 U®Un]nown 0 Other: Special HasMat actions required or spill > 55a1❑ g ., 00 Other mixed use Please complete the HarMat form 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 3610 Prison or jail, not juvenile 571 ❑Gas or service station 161 ❑Restaurant or cafeteria 419 1•-or 2-famil dwelling ❑ Y 599 ❑ Business office 162 ❑Bar/Tavern or nightclub 429❑Multi-family dwelling 615 ❑Electric generating plant 213 Elementary school or kindergarten 439 pg Rooming/boarding house 629 ❑Laboratory/science lab 215 ®High school or junior high 449 Commercial hotel or motel ❑ 700 ❑Manufacturing plant 241 ['College, adult education 459 Residential, board and care 819 311 ®Care facility for the aged ❑ ❑Livestock/poultry storage(barn) 311 Careifal 464❑Dormitory/barracks 882 ❑Non-residential parking garage ® 519 0 Food and beverage sales g g $91 ID Outside 936 ❑Vacant lot 981 ❑ Construction site 124 ['Playground or park 938 ❑Graded/care for plot of land 984 0 Industrial plant yard 655 [Crops or orchard 946 ❑Lake, river, stream 669 ['Forest (timberland) 951 F3i l dirOa right of wayLookup and enter a Property Use code only if ❑R g you have NOT checked a Property Use box: 807 Ill Outdoor storage area 960 [lather street Property Use 1439 I 919 [pump or sanitary landfill 961 ❑Highway/divided highway 931 ❑Open land or field 962 ❑Residential street/driveway I' carding/rooming house, I NFIRS-1 Revision 06/03/05 FIRE RESCUE 07009 02/23/2007 07-0017976 K1 Person/Entity Involved IRennisance I I I - I I-I—__—I Local Option Business name (if applicable) Area Code Phone Number II tt Check This Box if I I I I I I I I L.� Elsame address as Mr.,Ms., Mrs. First Name MI Last Name Suffix skip the three incident location. I I UI I I I� 'L�.J Then duplicate address Number prefix Street or Highway Street Type suffix lines. I I I I !Waterloo Post Office Box Apt./Suite/Room City (IA I 150703 I-I I State Zip Code More people involved? Check this box and attach Supplemental Forms (NFIRS-1S) as necessary K2 Owner 0 Same as person involved? Then check this box and skip I I I I - I I I 1 The rest of this section. Local Option Business name (if Applicable) Area Code Phone Number I I I I I I I 1 I I ® Check this box if Mr.,Ms., Mrs. First Name MI Last Name Suffix same address as incident location. I ( II I 1 I I I I Then skip the three I duplicate address Number Prefix Street or Highway Street Type Suffix lines. I I I I I -_Post Office Box Apt./Suite/Room City I II I-I 1 State Zip Code L Remarks Local Option Responded to trouble alarm. Power outage in the area from winter storm ac7Avated alarm. . , • 1 ( L Authorization IMOORE,M I !Moore, Michael IILT I 1311 1102Il_.21 I 20071 Officer in charge ID Signature Position or rank Assignment Month Day Year Check Box if® I MOORS,M I 'Moore, Michael I I LT I 1311 I L 02i l221 I 20071 same Position or rank Assignment Month Day Year as officer Member making report ID Signature in charge. FIRE RESCUE 07009 02/23/2007 07-0017976 A NM DD YYYY ❑Delete 107009 I IA ❑ I 02 11 231 I 2007 I 15 I I07-0017977 11 0001 NFIRS -1 Change Basic FDID State Incident Date Station Incident Number �k * * Exposure * ElNo Activity n, C B "Alaer u, n Census Tract 0008 00 BLocation* uc Module„eAIna Section tnativea Loca.,eation Specification". Use only for Wildland fires. ®Street address ( „,) I 1 016561 I 1 [SYCAMORE ( >� __I [ST I I`_] ❑Intersection Number/Milepost Prefix Street or Highway Street Type Suffix ❑In front of ['Rear of 1 1 'WATERLOO 1 'IA I 150703 1-[-.___I Apt./Suite/Room City State Zip Code ['Adjacent to (Directions Cross street or directions, as applicable Secondary Address Incident Type * Midnight is 0000 1'pEl Date & Times E2 Shift & Alarm 1 740 1 [Unintentional transmission of ( Check boxes if Month Day Year Hr Min Sec Local Option Type dates are the Incident same as Alarm ALARM always required lB 1 1 0 1[ 1 Aid Given or Received Date. Alarm * 1 021 1 23) 1 20071121:09:30 1 1 DShift or Alarms District Platoon ARRIVAL required, unless canceled or did not arrive 1 ['Mutual aid received 1 ILA Arrival I 021 I 231 I 2007E)21:28:oo ri3 2 ❑Automatic aid recv. Their FDID Their State CONTROLLED Optional, Except for wildland fires 3 ❑Mutual aid given p Special Studies' 4 []Automatic aid given I I ®Controlled 1 021 1 231 I 20071121:29:00 ! Local Option 5 ❑Other aid given Their LAST UNIT CLEARED, required except for wildland fires 1 ____1 Incident Number Last Unit Special Special N IIINone IE Cleared I 021 1 231 1 20071121:29:00 I Study ID# Study value F. Actions Taken * G1 Resources * G2 Estimated Dollar Losses & Values I Check this box and skip this LOSSES: Required for all fires if known. Optional , I_1 section if an Apparatus or for non fires. Personnel form is used. None 186 1 [Investigate I Apparatus Personnel Property $1 1 , L 0001 ,) 000( ❑ Primary Action Taken (1) Suppression I 1 1 1 Contents $1 1 , 1 0001,1 000) ❑ I I I -1 EMS 1 I Additional Action Taken (2) PRE-INCIDENT VALUE: optional 1 1 1 1 Other 1 0001J 1 00031 Property $1 1 , 1 0001,1 000_1 ❑ Additional Action Taken (3) ❑ Check box if resource counts include aid received resources. Contents $1 1 , 1 0001,1 00J((q��� 111 Completed Modules H1*Casualties1=1None H3 Hazardous Materials Release I Mixed Use Property 111Fire-2 Deaths Injuries N ENone IdN X Not Mixed 10 Assembly use Structure-3 Fire I I I 1 1 ❑Natural Gas: slow leak, no evavatios or HazMat actions 20 ®`Education use Service ['Civil Fire Cas.-4 2 O Propane gas: <n lb. tank (as in home BBC grill) 33 Medical use " [Fire Serv. Cas.-5 civilian' 11 I 3 []Gasoline: vehicle fuel tank or portable container 40 Residential use 0EMS-6 H2 4 [Kerosene: fuel burning 51 —Row of stores Detector g equipment or portable storage 53 —Enclosed mall [HazMat-7 Required for Confined Fires. 5 ❑Diesel fuel/fuel Oil:vehicle fuel tank or portable 58 --Bus. & Residential [Wildland Fire-8 1❑Detector alerted occupants Apparatus-9 6 ❑Household solvents: home/office spill, cleanup only 59 ®Office use 60 Industrial use ❑ 7 ❑MOtOr oil: from engine or portable container ®Personnel-10 2[1]Detector did not alert them 8 ❑ paint cans totaling e 55 gallons 63 —Military use Paint: from ❑Arson-11 65 Farm use U❑Unknown 0 []Other: Special HazMat actions required or spill > 55ga1., 00 m®Other mixed use _ Please complete the HazMat form — J Property Use* Structures 341❑c:Linic,clinic type infirmary 539 [Household goods,sales,repairs 342E Doctor/dentist office 579 ❑Motor vehicle/boat sales/repair 131 ['church, place of worship 3610Prison or jail, not juvenile 571 ❑Gas or service station 161 ['Restaurant or cafeteria 419E 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 ['Manufacturing plant 241 ['College, adult education 459❑Residential, board and care 819 ❑Livestock/poultry storage(:barn) 311 []Care facility for the aged 464 LIDormitory/barracks 882 ❑Non-residential parking garage 331 ElHospital 519❑Food and beverage sales 891 ❑Warehouse Outside 936 [Vacant lot 981, E 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 669 Foresmberlan Lookup and enter a Property Use code only if ❑ t (ti d) 951 ❑Railroad right of way you have NOT checked a Property Use box: 807 [Outdoor storage area 960 ❑Other street Property Use 1839 1 919 [Dump or sanitary landfill 961 ❑Highway/divided highway 931 ❑open land or field 962 EResidential street/driveway !Refrigerated storage I NFIRS-1 Revision 06/03/05 FIRE RESCUE 07009 02/23/2007 07-0017977 K1 Person/Entity Involved (Crystal Distibution I I I I I I I Local Option Business name (if applicable) - i Area Code Phone Number i I I I I I ❑Check This Box if i same address as Mr.,Ms., Mrs, First Name MI Last Name Suffix incident location. Then skip the three 11 I tJ duplicate address Number lines. Prefix Street or Highway Street Type Suffix I I I !Waterloo I Post Office Box Apt./Suite/Room City IIA II50703 I-I I State Zip Code 1 El More people involved? Check this box and attach Supplemental Forms (NFIRS-1S) as necessary K2 Owner 0 Same as person involved? Then check this box and skip I I L. I - I The rest of this section. I i Local Option Business name (if Applicable) Area Code Phone Number I I I I I l I I I I ❑ Check this box if Mr.,Ms., Mrs. First Name MI Last Name same address as Suffix incident location. I I I_J I I I L� Then skip the three � duplicate address Number Prefix Street or Highway lines. I Street Type Suffix II I _1 Post Office Box Apt./Suite/Room City - U I State Zip Code - L Remarks Local Option Notifier response. Delayed response due to power outage at Sta. #5. Overhead door had to be j opened and closed manually. On arrival met maintenance and was advised that the power outage in the area activated alarm. i � 4 ( I, Authorization �� . m _r _m_� ICUTSFORTH,J 1 ICutsforth, Jeff LT 1 I I 1305 J I 021 ( 23) I 20071 Officer in charge ID Signature Position or rank Assignment Month Day Year Check Box if MOORE,M Moore, Michael LT I same ❑ I I I I I311 L 021 I� 2007! as Officer Member making report ID Signature Position or rank Assignment Month Day Year in charge. FIRE RESCUE 07009 02/23/2007 . 07-0017977 A MM DD YYYY Delete NF:CRS -1 107009 I IIA I I 02 1 1 231 I 2007 1 13 I 107-0017980 I I 0001 ®Change Basic FDID State Incident Date Station Incident Number Exposure * ❑No Activity Module In Section B .Alternative Location Specification". Use only for Wildland fires. Census Tract 0017 _ ®'Z B Location* MStreet address 1 018251 I ILOGAN (''';AI IAV I L___J ❑Intersectiori Number/Milepost Prefix Street or Highway Street Type Suffix ❑In front of ❑Rear of I 1 'WATERLOO 1 'IA I 150703 1-L_ ____I Apt./Suite/Room City State zip Code ❑Adjacent to 1 ❑Directions Cross street or directions, as applicable L ____J L 17' 0 Secondary Address Incident Type4n Midnight is 0000 CEl Date & Times E2 Shift & Alarm 1 740 1 'Unintentional transmission of 1 Check boxes if Month Day Year Hr Min Sec Local Option dates are the - Incident Type same as Alarm ALARM always required 1B I 1 0 11 'L Aid Given or Received* Date. Alarm I 02) 231 1 20071121:12:56 1 7� Shift or Alarms nistrict 1� Platoon ARRIVAL required, unless canceled or did not arrive 1 ❑Mutual aid received 1 11 I Arrival * I 021 I 231 ( 20071121:24:001 H3 2 ❑Automatic aid recv. Their FDID Their State CONTROLLED Optional, Except for wildland fires 3 ❑Mutual aid given p Special St.udieSl 4 ®Automatic aid given I_ ] ®Controlled 1 021 1 231 I 20071121:30:00 1 Local Option 5 ❑Other aid given Their LAST UNIT CLEARED, required except for wildland fires I I I_ Incident Number Last Unit Special Special N 0None 1 021 1 2311 20071121:30:00 1 study IDi Study Value ® Cleared F' Actions Taken* G1 Resources * G2 Estimated Dollar Losses & Values Check this box and skip this section if an Apparatus or LOSSES: Required for all fires if known. Optional , for non fires. None 186 i 'Investigate I Personnel form is used.Apparatus Personnel property $I 1 , 1 00 01,1 0001 Primary Action Taken (1) Suppression 1 1 1 1 Contents $1 II 0001,1 0001 IJ 1 I I —1 EMS Additional Action Taken (2) I 1 PRE-INCIDENT VALUE: Optional I 1 1 1 Other 1 00011 I 00031 Property $1 1 , 1 0001,1 0001 t Additional Action Taken (3) ❑ Check box if resource counts include aid received resources. Contents $1 1 , 1 0001,1 00J El Completed Modules Hl*Casualties®None H3 Hazardous Materials Release I Mixed Use Property ❑Fire-2 Deaths Injuries N CD None TIN X Not Mixed Fire 10 Assembly use Structure-3 I I I I 1 ❑Natural Gas: slow leak, no evauation or HazMat actions 20 Education use Service Medical use ❑Civil Fire Cas.-4 2 ❑Propane gas: 421 lb. tank (as in home eau grill) 33 ['Fire Serv. Cas.-5 Civilianl 1 1 1 3 ❑Gasoline: vehicle fuel tank or portable container 40 Residential use ❑}'sMs-6 51 —Row of stores H2 Detector 4 ❑Kerosene: fuel burning equipment or portable storage 53 Enclosed mall ❑HazMat-? Required for Confined Fires. 5 ❑Diesel fuel/fuel oil:vehicle fuel tank or portable 58 :Bus. & Residential ❑Wildland Fire-8 111Detector alerted occupants 6 ❑Household solvents: home/office spill, cleanup only 59 Office use ❑Apparatus-9 60 —Industrial use 7 C]MOt Or oil: from engine or portable container ®Personnel-10 2❑Detector did not alert them 8 C�Paint: from paint cane totaling< 55 gallons 63 Military use L ❑Arson-11 i7 Unknown 65 Farm use ❑ 0 ❑Other: special HazMat actions required or spill s ssgal., 00 Other mixed use Please complete the HazMat form 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 3 61❑Prison or jail, not juvenile 571 ❑Gas or service station 161 ❑Restaurant or cafeteria 4190 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 ❑Manufacturing plant 241 ['College, adult education 459❑Residential, board and care 819 ❑Livestock/poultry storage(barn) 311 Deere facility for the aged 464❑Dormitory/barracks 882 ❑Non-residential parking garage 331 ppospital 5 19❑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 669 Forest (timberland) 951 [_]Railroad of wayLookup and enter a Property Use code only if ❑ right you have NOT checked a Property Use box: 807 ❑Outdoor storage area 960 Other street ❑ Property Use 1331 1 919 ❑Dump or sanitary landfill 961 ❑Highway/divided highway 931 C Open land or field 962 ❑Residential street/driveway 'Hospital - medical or 1 NFIRS-1 Revision 06/03/05 • FIRE RESCUE 07009 02/23/2007 07-0017980 1 Person/Entity Involved I _____I I I - I '-I Local Option Business name (if applicable) Area Ccde Phone Number I I I IIII III 0 Check This Box if Mr.,Ms., Mrs. First Name MI Last Name Suffix �J same address as incident location.Then skip the three I I I I I I I I L.__1 duplicate address Number lines. Prefix Street or Highway Street Type Suffix I I I I I Post Office Box Apt./Suite/Room City II I I-I I State Zip Code More people involved? Check this box and attach Supplemental Forms (NFIRS-1S) as necessary K2 Owner 0 Same as person involved? I Then check this box and skip I I I - I I Li___1 The rest of this section. Local Option Business name (if Applicable) Area Code Phone Number I I I I L_J L ___ I L i ❑ Check this box if Mr.,Ms., Mrs. First Name MI Last Name Suffix same address as incident location. I I L._ I J I I I L.� Then skip the three duplicate address Number Prefix Street or Highway Street Type Suffix lines. I I I I I Post Office Box Apt./Suite/Room City I II I-I State Zip Code , L Remarks .r Local Option Engine #303 dispatched to Allen Hospital for activated fire alarm. Code 3 response w/o incident. Nothing visible on arrival. Upon investigation floor three showed a duct sensor activation. Maintenance advised they could find nothing with the activated sensor and it has activated a false alarm prior. Maintenance isolated power to duct and shut off power supply. Maintenance silenced alarm. a #303 10-8 @ 2130 i ! I, Authorization s. ___ �___ _._a_ _�_ (PETERSEN,BEN I ! Petersen, Ben I IENGR I I I I 021 123I I 20071 Officer in charge ID Signature Position or rank Assignment Month Day Year Chec samek El I I I I I I J ( ( I I I I Box if PETERSEN,BEN Petersen, Ben ENGR 02 23 2007 as Officer Member making report ID Signature Position or rank Assignment Month Day Year in charge. FIRE RESCUE 07009 02/23/2007 07-0017980 A MM DD yyyY ❑Delete NFIRS -1 107009 1 IA [ 02 I 1 231 1 2007 1 16 I L07-0017910 I 1 0001 ❑Change Basic FDID * State* Incident Date * Station Incident Number * Exposure * No Activity L_J ', rv',,.e %; a ,.< .�,,,,.< n ,n,a , < , ,,—( rueu'c „ 7 S,a,.,,, < Census Tract 0014 - 00 BLocation* 14odule In Section e "'Alternative`LocationsSpecificae ion°.eUse only for Wi ldland<fire . Street address 5- 3 I 1351 1 I 'WOODSTOCK 1 IRD 1 L_J El Intersection Number/Milepost Prefix Street or Highway Street Type Suffix ❑In front of I I (WATERLOO I 'IA I 150703 J-L__ I ®Rearr of Zip City State Code ❑Adjacent to ❑Directions - -- a Cross street or directions, as applicable v 0 8 .3j.J -. t'i d Secondary Address 111 Incident fire e Check boxes Datef Month Day Midnight e is 0 Hr0 Mtn Sec h ? ("; Type }�,1 & Times �+ 2 Shift & Alarm I I 'Building ILocal Option dates are the y Incident Type same as Alarm ALARM always required 1B I .I 011 Date. I 021 231 1 20071117:25:57 1 It; D Aid Given or Received* Alarm * _ Shift or Alarms District Platoon ARRIVAL required, unless canceled or did not arrive 1 ❑Mutual aid received L II Arrival * 1_92.1 ( 231 1 20071117:33:00 1 ni3 2 []Automatic aid recv. Their FDID Their State CONTROLLED Optional, Except for wildland fires Special Studies 3 0 Mutual aid given 4 []Automatic aid given I I ®Controlled I 021 I 231 I 20071118:34:00 I Local Option 5 ®Other aid given Their LAST UNIT CLEARED, required except for wildland fires I I L_ l N ��None Incident Number Last Unit SpeciI 021 I 231 I 20071118:34:00 I Study alD# Study l ValueEl Cleared F Actions Taken * G1 Resources * G2 Estimated Dollar Losses & Values 1E�``(( Check this box and skip this ICJ section if an Apparatus or LOSSES: Required for all fires if known. Optional Personnel form is used. for non fires. None Ill 1 lExtinguishment by fire I Apparatus Personnel Property $1 1 , I 0041,1 0001 ❑ Primary Action Taken (1) Suppression I 00061 I 00141 Contents $1 1 , 1 0011,1 Od9] ❑ 112 I 'Salvage & overhaul Additional Action Taken (2) EMS I I I 1 PRE-INCIDENT VALUE: optional I 1 1 1 Other 1 11 Property $1 1 , 1 0001,1 000-I El Additional Action Taken (3) r1 Check box if resource counts U include aid received resources. Contents $1 _ 1 , 1 0001,1 0001 CI Completed Modules H1*Casualties®None H3 Hazardous Materials Release I Mixed Use Property X Fire-2 Deaths Injuries N iI None NN X Not Mixed 10 Assembly use X Fire Structure-3 I J I I 1 []Natural Gas: slew leak, no e�aeatien or HazMat actiena Service 20 —Education use ervce ❑Civil Fire Cas.-4 2 []Propane gas: <21 lb. tank (as in home HBO grill) 33 ®Medical use ❑Fire Serv. Cas.-5 Civilian) I I 1 3 [1 Gasoline: vehicle feel tank or portable container 40 ®Residential use ® q p g EMS-6 H2 Detector 4 []Kerosene: feel burning equipment or portable storage 51 Row of stores 53 Enclosed mall 0HazMat-7 Required for Confined Fires. 5 ❑Diesel fuel/fuel oil:vehicle feel tank or portable 58 Bus. & Residential ❑Wildland Fire-8 6 []Household solvents: home/office spill, cleanup only 59 ®Office use 1❑Detector alerted occupants ®Apparatus-9 60 —Industrial use PP 7 []Motor oil: from engine or portable container — ®Personnel-10 2ElDetector did not alert them 8 Paint: from paint cans totaling< 55 gallons 63 ®Military use ❑ 9 sa 65 Farm use LIArson-11 Up Unknown 0 []Other: special HazMat actions required or spill a 559a1., 00 --Other mixed use Please complete the HazMat form -- c.c.. Property Use* Structures 341❑Clinic,clinic type infirmary 539 ❑Household goods,sales,repairs 3420 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 4 19[i 1-or 2-family dwelling 599 Business office 162 ❑Bar/Tavern or nightclub 42 9[]Multi-family dwelling 615 El Electric generating plant 213 ❑Elementary school or kindergarten 4 39❑Rooming/boarding house 629 ❑Laboratory/science lab 215 ❑High school or junior high 44 9❑Commercial hotel or motel 700 ['Manufacturing plant 241 ❑College, adult education 4 5 9❑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 1:Graded/care for plot of land 984 ❑ Industrial plant yard 655 ❑Crops or orchard 946 ❑Lake, river, stream 669 Forest (timberland) Lookup and enter a Property Use code only if ❑ 951 0Railroad right of way you have NOT checked a Property Use box: 807 ['Outdoor storage area 960 ❑Other street Property Use 1419 1 919 ❑Dump or sanitary landfill 961 ❑Highway/divided highway 931 ❑Open land or field 962 ❑Residential street/driveway 11 or 2 family dwelling NFIRS-i Revision 06/03/05 FIRE RESCUE 07009 02/23/2007 07-0017910 K{1 Person/Entity Involved I I I I - I J-I iI Local Option i Business name (if applicable) Area Code Phone Number ®Check This Box if I I I I l I IJ L same address as Mr.,Ms., Mrs. First Name MI Last Name f Suffix incident location. Then skip the three I I I I _1 I_. I L___1 _. duplicate address Number Prefix Street or Highway Street lines. g y Type Suffix I _J I I Post Office Box Apt./Suite/Room City I I I I-I I State zip Code I]More people involved? Check this box and attach Supplemental Forms (NFIRS-1S) as necessary K2 Owner El Same as person involved? Then check this box and skip I I I319 I - 1234 J I9930 The rest of this section. Local Option Business name (if Applicable) Area Code Phone Number l J (Frank 11 I I Magsamen _1 L___ I ® Check this box if Mr.,Ms., Mrs. First Name MI Last Name Suffix same address as 1 incident location. 1135 I I I IWOODSTOCK I I RD I L-1 Then skip the three --- duplicate address Number Prefix Street or Highway Street Type Suffix lines. I ( I I (WATERLOO Post Office Box Apt./Suite/Room City IIA I 150703 I-I--._I • State Zip Code L Remarks Local Option On 02/23/2007 at 17:29 dispatched To 135 WOODSTOCK RD /WATERLOO, IA 50703 . The location is a 1 family dwelling. The incident was determined to be a building fire. 17 :33 :00 arrived on scene. Upon arrival engine 306 noted owner inside home at front dormer with window open and using a water misting bottle trying to extinguish the fire. Light smoke was noted around the window and from a roof vent to the north of the window . An axe was used to open up the window area trim and wall where smoke could be seen. Fire was extinguished with a water gun. Additional engine companies arrived on the scene and the exterior of the window area was laddered and exterior trim was removed as well. Areas could be seen that had burn marks and soot at the upper corners of the window, the lower left area, and a number of other areas in the dormer area. Plaster and trim was removed back to non burning wood around the window. Access was gained to an attic area to the south of the window where smoke was noted upon arrival. No active fire or smoke was found in the area. The thermal imager was used to help located hot spots. Salvage tarps and tubs were used to contain the damage and remove any materials involved. Owner: Frank Magsamen 234-9930 Insurance through PDCM and Frank Dowey with Auto Owners Owner was in phone contact with Insurance and repair possibilities prior to leaving the scene. L Authorization I POWELL,V I ' Powell, Virg I IBC I I I I 021 123I I 20071 Officer in charge ID Signature Position or rank Assignment Month Day Year Check Box if ❑ I WOELBER,D I I Woelber, Dean I ILT I J I. 02I LE] I 20071 same Position or rank Assignment Month Day Year as officer Member making report ID Signature in charge. FIRE RESCUE 07009 02/23/2007 07-0017910 A MM DD YYYY ❑Delete I [ J 1 I 1 I 1 I I I I I ❑ NFIRS -2 07009 IA 02123 2007 6 07-0017910 000 Change FDID StateIncident Number Fire * * Incident Date * Station. * Exposure * ®No Activity B Property Details C On—Site Materials❑None Complete if there were any significant amounts of commercial,industrial, energy or or Products agricultural products or materials on the Property, whether or not they became involved Enter up to three codes. Check one B 1 I 0 0 0 lI ❑Not Residential or more boxes for each code entered. g 1 Bulk storage or warehousing Estimated Number of residential living units in 1310 1 IWood, Other 12 ®Processing or manufacturing building of origin whether or not all units on-site material (1) 3 _Packaged goods for sale became involved 4 Repair or service 1 Bulk storage or warehousing B2 I 0011 ❑Buildings not involved I I I 12 __Processing or manufacturing Number of buildings involved on-site material (2) 3 _Packaged goods for sale 4 _Repair or service B3 I I ❑ 1 Bulk storage or warehousing None = II I I Acres burned 2 ,__Processing or manufacturing (outside fires) ❑Less than one acre On-site material (3) 3 ®Packaged goods for sale 4 Repair or service Cause of Ignition Human Factors D Ignition E1 �3 "'Check box if this is an exposure report. Contributing To Ignition Skip to section c Check all applicable boxes D1 12! I lAwning 1 1 ❑Intentional 1 ❑Asleep LINone Area of fire origin * 2 ['Unintentional 2 ❑Possibly impaired by 3 ❑Failure of equipment or heat source alcohol or drugs D2 73 Lightning discharge 4 ®Act of nature 3 ❑Unattended person 1 I I I 5 ['Cause under investigation 4 ❑Possibly mental disabled Heat source * U ❑Cause undetermined after investigation 5 ['Physically Disabled Factors C ontributing To Ignition 6 ❑Multiple persons involved D3p IlExterior wall covering 1 E2 - Item first ignited 1 Check sox if fire spree j ❑None 7 ❑Age was a factor ®was confined to object [62 (Storm I of origin Estimated age of L- Factor Contributing To Ignition (I) D4 I63 I (Sawn wood, including I person envolved Type of material Required only if item first [______I I f first ignited ignited code is 00 or <70 J Factor Contributing To Ignition (2) 1 ❑Male 2 ❑Female Fi Equipment Involved In Ignition F.2 Equipment Power G Fire Suppression Factors ❑None If Equipment was not involved,Skip to I Enter upto three codes. Section G L—� I I iti None I II Equipment Power Source Equipment Involved F3 Equipment Portability IITNN I 'None I Fire suppression factor (1) Brand I _ I 1 ❑portable Model I I 2 ['Stationary I I I Fire suppression factor (2) Serial #I Portable equipment normally can be moved by one person, is designed tc be use in multiple locations, and Year I I requires no tools to install. Fire suppression factor (3) Mobile Property Involved Local Use Ea p Y Ire Mobile Property Type & Make ❑Pre-Fire Plan Available ❑None I I I Some of the information presented in this report may be based upon reports 1 ®Not involved in ignition, but burned Mobile property type from other Agencies EArson report attached 2 ❑Involved in ignition, but did not burn 3 ❑Involved in ignition and burned I I I. I ❑Police report attached Mobile property make ❑Coroner report attached ❑Other reports attached I I I I Moblie property model Year I I UI I License Plate Number State VIN Number NFIRS-2 Revision 01/19/99 FIRE RESCUE 07009 02/23/2007 07-0017910 A MM DD yyyy NFIRS - 9 1 07009 1 11A I [ 21 1 231 1 20071 1 6 1 1 07-0017910 I I 0001 ❑Delete Apparatus or FDID state Incident Date • * * Station Incident Number * Exposure * ❑Change Resources BApparatus or * Date and Times Sent Number Use Actions Taken Resource Check if same as alarm date of * Check ONE box for each apparatus to indicate Month DayYear Hour Min People main use at the Pe0 le incident. 1 ID 1300 �L Dispatch (211 211 2311 20071 117:29 1 �_ ®Suppression 1 111 1 1 Arrival Dni 2I 231I 20071 117:36 I X 1 11 ElmsType I91 1 Clear D I 211 2311 20071 118:30 1 ❑Other I I L_l 2 ID 1301 J Dispatch KIII1 211 2311 20071 117:29 1 Arrival 2 23 2007 17:37 MI suppression 1111 I Type 111 1 ®I I I l i 1 1 I n 1 . 41 ❑EMs Clear ®1 211 2311 20071 118:00 1 ['Other I I 1 3 ID 1304 I Dispatch 1*1 1 Al 2 31 I 20071 117:29 1 KISuppreasion I 111 I 1 Arrival ®I 2I 12311 20071 117:35 1 X I 31 ❑EMs Type 111 1 Clear 1E11 211 2311 20071 118:27 1 ®OtherL__1 I 1 4 ID 1306/36_1 Dispatch 1 I 211 2311 20071 117:29 1 ®Suppression I 1 I 1 Arrival ®I 211 2311 20071 117:33 1 X I Type 111 1 31 ❑EMS Clear ®1 211 2311 20071 118:34 1 ®OtherI I I I 5 ID 1308 pr-Dispatch ®I 211 23I I 201� 117:29 1 *�suppression 1111 I 1 Arrival g I �2 1 231 L 201_J 117:35 1 IX I 31 ❑EMs Type 113 1 Clear NI 211 2311 20071 118:27 1 ❑ I I I Other 6 ID 1338 I Dispatch f*11 211 2311 20071 117:29 1 Suppression I 111 1 I Arrival ®I 211 23I I 20121 117:35 1 X I OI ❑EMs Type 176 1 Clear ®I 211 2311 20071 118: ❑ 34 J I I I Other ID I 1 Dispatch El _lI 11____I I I �,. �z_� +_ _��_.__ ['Suppression I I L.___I Arrival El I1 II EMS I Clear ❑I I L _ e Type _ I L _I I I I 1 ❑®Other I I I 1 I 8 ID Dispatch ❑I I L_1 L_—I I I Arrival ❑ � I 11 I I _1 I ❑Suppression 1 I I I IType I Clear ❑I 1 L_ �1 l L I I ❑Other I I ❑ENS i I 1�1 ...._�.__... ____ 9 ID ___t Dispatch ❑LAI 11___I I I ®Suppression I I L I Arrival DI 11 1 Le__I I 1__1 ❑EMS Type I Clear ❑1 I L__1 I 1 1 Other 1 1 1 Type of Apparatus or Resources Ground Fire Suppression Marine Equipment More Apparatus? 11 Engine 12 Truck or aerial 51 Fire boat with pump Use Additional 13 Quint 52 Boat, no pump 50 Marine apparatus, other Sheets PP 14 Tanker & pumper combination 16 Brush truck Support Equipment 17 ARF (Aircraft Rescue and Firefighting) 61 Breathing apparatus support Other 10 Ground fire suppression, other 62 Light and air unit 91 Mobile command post Heavy Ground Equipment 60 Support a pparatus, other 92 Chief officer car 21 Dozer or plow 93 HazMat unit Medical & Rescue 94 Type 1 hand crew 22 Tractor 71 Rescue unit 24 Tanker or tender 95 Type 2 hand crew 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 42 Helitanker 70 Medical and rescue unit,other UU Undetermined 43 Helicopter 40 Aircraft, other NFIRS-9 Revision 11/17/98 FIRE RESCUE 07009 02/23/2007 07-0017910 MM DD YYYY ❑Delete NFIRS -1 [ Io70o9 I IIA 1 1021 1 241 I 2oo7 j 18 I 107-0018460 11 00o I ❑Change Basic FDID State Incident Date Station Incident Number * * * Exposure * Elko Activity r ' yf res Census Tract n 7 B Location* u Module`InaSeoction flt°Alto native`In cation>Specification"jUUse only Eor�Wildlandcfij LL1 e11LL jjjc I Q Q 2 1-�n V 1 ®Street address I 41451 I I (North (.., ,. I I 1 lJ AVE ❑Intersection Number/Milepost Prefix Street or Highway g Y Street Type Suffix ['In front of ❑Rear of (Waterloo 1 IIA 1150702 1-I__ I Apt./Suite/Room City State Zip Code ❑Adjacent to El Directions i Cross street or directions, as applicable I I Secondary Address C Incident Type * .,_, �� --� 1El Date & Times Midnight is 0000 E2 Shift & Alarms 1 444 1 (Power line down I Check boxes if Month Day Year Hr Min Sec Local Option Type dates are the Incident same as Alarm ALARM always required IC 8 Aid Given or Received* Date. D Alarm * 1 021 I 241 1 20071122:56:00 I Shift o I I oil I r Alarms District Platoon ARRIVAL required, unless canceled or did not arrive 1 ['Mutual aid received I II ® Arrival * 1 021 1 241 1 20071123:09:00 1 E3 2 ['Automatic aid recv. Their FDID Their State CONTROLLED Optional, Except for wildland fires 3 ['Mutual aid given p P Special Studies) 4 ['Automatic aid given I �I ®Controlled 1 021 1 241 1 20071123:19:00 1 Local Option 5 ['Other aid given Their LAST UNIT CLEARED, required except for wildland fires I I Incident Number Last Unit Special Special N ®None III Cleared 1021 I 241 I 20071123:19:00 1 study IDp Study Value F Actions Taken * G1. Resources * G2 Estimated Dollar Losses & Values Mr,� Check this box and skip this section if an Apparatus or LOSSES: Required for all fires if known. Optional No for non fires. Personnel form is used. None 1$6 1 (Investigate I Apparatus Personnel Property $1 I , I 0001 ,1 0001 ❑ Primary Action Taken (1) Suppression I I I I 1 1 Contents $I 1 , 1 0001,1 0001 ❑ Additional Action Taken (2) EMS I ( I 1 PRE-INCIDENT VALUE: Optional I 11 I Other 1 00011 I 00031 • ❑ Property $1 I , I 0 0 01,I 0001 Additional Action Taken (3) ❑ Check box if resource counts ❑ include aid received resources. Contents $1 Id I 0001,I 0001 Completed Modules Hl*Casualties❑None I3 Hazardous Materials Release I Mixed Use Property ❑Fire-2 Deaths Injuries N E None NN X Not Mixed 10 Assembly use ❑Structure-3 Fire I I 1 1 ['Natural Gas: slow leak, no evauation or HazMat actions 20 ®Education use Service ® ID Civil Fire Cas.-4 2 ['Propane gas: <zl lb. tank .as in home eeo grill) 33 Medical use ®Fire Serv. Cas.-5 Gasoline: vehicle fuel tank or 40 ®Residential use civilian] I I I 3 ❑ portable container ❑EMS-6 4 ❑Kerosene: fuel burning equipment or portable storage 51 ...Residential Row of stores H2 Detector 53 Enclosed mall 0 HazMat-7 Required for Confined Fires. 5 ❑Diesel fuel/fuel oil:vehicle fuel tank or portable 58 ®Bus. & Residential ❑wildland Fire-8 6 ['Household solvents: home office spill, clean ® 10 Detector alerted occupants p only 59 Office use Apparatus-9 ® 7 ['motor oil: from engine or portable container Industrial use 60 63 —Military use ®Personnel-10 2❑Detector did not alert them 8 ®paint: from paint cane totaling< 55 gallons e ❑A rson- 65 Farm use 11 Up Unknown 0 ❑Other: Special HazMat actions required or spill > 559.1- 00 Other mixed use _ Please com.lete the HazMat form 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 3610 Prison or jail, not juvenile 571, ❑Gas or service station 161 ❑Restaurant or cafeteria 4 19® 1-or 2-family dwelling 599 [' Business office 162 ❑Bar/Tavern or nightclub 42 9❑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 ❑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 669 D Forest (timberland) Lookup and enter a Property Use code only if 951 ['Railroad right of way you have NOT checked a Property Use box: 807 ❑Outdoor storage area 960 ❑Other street Property Use 1419 1 919 Dump or sanitary landfill 961 ❑highway/divided highway 931 ['Open land or field 962 ❑Residential street/driveway 11 or 2 family dwelling NFIRS-1 Revision 06/03/05 FIRE RESCUE 07009 02/24/2007 07-0018460 ICl Person/Entity Involved I I I I - I ( L--__I Local Option Business name (if applicable) Area Code Phone Number I I I I L—J I I L—I EllCheck This Box if Mr.,Ms., Mrs, First Name MI Last Name Suffix same address as incident location. I _� I I �. Then skip the three U duplicate address (Number I Prefix Street or Highway Street Type Suffix lines. I I I I I Post Office Box Apt./Suite/Room City III I—I J State Zip Code ['More people involved? Check this box and attach Supplemental Forms (NFIRS-1S) as necessary K2 Owner Ei Same as person involved? I I I I I Then check this box and skip I I __.____J The rest of this section. i Local Option Business name (if Applicable) Area Code Phone Number I I I I II I I I I ❑ Check this box if Mr.,Ms., Mrs. First Name MI Last Name Suffix same address as I incident location. I I LJI I I I 'I u Then skip the three Street Type Suffix duplicate address Number Prefix Street or Highway lines. I I I I I Post Office Box Apt./Suite/Room City I I I—L_--J State Zip Code __ _..,,_.,.3 .....--..,..j L Remarks 1 Local Option Power line down due to ice storm. Service line to the residence was hit by a falling tree limb. Called for Mid-American Energy. -.ten....._ ________ _ , �-., ,. . -_ ® _ ___ _ ..-_:._-.. .._..__. L Authorization I FROST,J I ' Frost, John I ILT I I J I 021 125I L 2001 Officer in charge ID Signature Position or rank Assignment Month Nay Year Boxcif Q I , I 'Frost, I ILT I I 11 021 125I I 20071I FROST J Frost John same Position or rank Assignment Month Day Year as Officer Member making report ID Signature in charge. FIRE RESCUE 07009 02/24/2007 07-0018460 i A MM DD yyyy ❑Delete 107009 1 2 102 I L 241 I 2007] 18 I 107-0018441 I I 0001 ❑ NFIRS -1 Change Basic FDID * State* Incident Date * Station Incident Number * Exposure ir ❑No Activity u�.ecx ru.a J n turns r.,ai CTr' ucxoe .u� r�us a.h..uei.� .n p�uv.ueu un c..e .v .u.auu i.e 10029 ,� B 1—Module In Section B ^Alternative Location Specification". Use only for wildland fires. Census Tract Q Q g 1_LQ 1 I LOCatlOn�c M Street address (� ®Intersection 1 3091 1 1 belle �''y 1 1ST I I 1 Number/Milepost Prefix Street or Highway Street Type Suffix ❑In front of ❑Rear of 1 1 Waterloo I IIA I 150702 I-L___ Apt./Suite/Room City State Zip Code ❑Adjacent to I ❑Directions Cross street or directions, as applicable !) _> J Secondary Address Incident Type ypMidnight is 0000 ._.,, El Date & Times E2 Shift & Alarm 1 440 I (Electrical wiring/equipment I Check boxes if MonthLocal Option Da Year Hr Min Sec Incident Type dates are the y1 same as Alarm ALARM always required I C ( I Q 1! L$ D Aid Given or Received Date. Alarm * 1 021 1 241 I 20071121:48:00 1 Shift or Alarms District Platoon . ARRIVAL required, unless canceled or did not arrive 1 ['Mutual aid received I II I ®❑ l Arrival * 1 021 1 241 I 20071121:56:001 E3 2 Automatic aid recv. Their FDID Their State CONTROLLED O 3 Mutual aid given ptional, Except for wildland fires Special al StlldieSl 4 ❑Automatic aid given I _ ®Controlled 1 021 I 241 I 20071122:13:00I Local Option 5 ❑Other aid given Their LAST UNIT CLEARED, required except for wildland fires I I L Incident Number Last Unit N ®None Special Special ® Cleared 1 021 1 241 I 20071122:13:00 1 study IDq Study Value F Actions Taken * G1 Resources * G2 Estimated Dollar Losses & Values (K Check this box and skip this LOSSES: Required for all fires if known. Optional LL section if an Apparatus or for Personnel form is used. non fires. 186 1 'InvestigateNone Apparatus Personnel Property $1 1 , 1 000_1 11 0001 ❑ Primary Action Taken (1) Suppression 1 11 I Contents $1 I , 1 0001,1 0001 ❑ I 1I EMS II Additional Action Taken (2) PRE-INCIDENT VALUE: Optional I I L 1 Other 1 00011 1 00031 $1 Property 1 , 1 0001,1 0001 ❑ Additional Action Taken (3) I'i Check box if resource counts include aid received resources. Contents $1 I , 1 0001,1 0001 ❑ Completed Modules Hi*Casualties❑None H3 Hazardous Materials Release I Mixed Use Property ❑Fire-2 Deaths Injuries N El None NhY ;{Not Mixed Structure-3 Fir Sere t 10 ®Assembly use ❑ I J 1 1 I 1 ❑Natural Gas: slow leak, no evauation Sr HasMat actions 20 °'Education use Civil Fire Cas.-4 vice _ ❑ 2 ['Propane Propane gas: <21 lb. tank (as in home BB°grill) 33 Medical use ❑Fire Serv. Cas.-5 Civilian' 1 1 I 3 ❑Gasoline: vehicle fuel tank or portable container 40 ®Residential use EMS-6 fuel burnin equipment51 Row of stores 4 ❑Kerosene: g or portable storage '2 Detector 53 Enclosed mall ❑HazMat-7 5 ❑Diesel fuel/fueloil Required for Confined Fires. :eshicle fuel tank or portable 58 —Bus. & Residential ❑wildland Fire-8 1❑netector alerted occupants 6 ❑Household solvents: home/office spill, cleanup only 59 Office use Li Apparatus-9 7 ❑Motor oil: from engine or60 ®Industrial use ®Personnel-10 2❑Detector did not alert them Portable container 63 Military use $ ❑Paint: from paint cans totaling a 55 gallons ❑Arson-11 U❑Onknown 0 Other: special HssMat notions required or spill SSgal„ 65 m Farm use ❑ 00 ®Other mixed use Please complete the NarMat form — J Property Use* Structures 34 1❑Clinic,clinic_ type infirmary 539 ❑Household goods,sales,repairs 342❑Doctor/dentist office 579 ❑Motor vehicle/boat sales/repair 131 ['Church, place of worship Prison orjail, notjuvenile 161 ❑Restaurant or cafeteria 361❑ 571 [:1 Gas or service station 4 19® 1-or 2-family dwelling 599 ❑ Business office 162 ❑Bar/Tavern or nightclub 429 Multi-famil 213 Ill Elementary school or kindergarten ['Multi-family y dwelling 6 15 III Electric generating plant 43 9❑Rooming/boarding house 629111 Laboratory/science lab 215 ❑High school or junior high 449❑Commercial hotel or motel 700 ❑Manufacturing plant 241 ❑College, adult education 459❑Residential, board and care 819 ❑Livestock/poultry storage(barn) 311 ❑Care facility for the aged 4 64❑Dormitory/barracks 882 ❑Non-residential parking garage 331 ❑Hospital 519 Food and beverage sales ❑ g 891 ❑Warehouse Outside 936 ❑Vacant lot 981 El 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 ❑RallrOad right 669 El Forest (timberland) 951 of wayLookup and enter a Property Use code only if you have NOT checked a Property Use box: 807 ❑Outdoor storage area 960 ❑Other street Property Use 1419 1 919 ODump or sanitary landfill 961 ❑);ighway/divided highway 931 ❑open land or field 962 ❑Residential street/driveway 11 or 2 family dwelling NFIRS-1 Revision 06/03/05 -FIRE RESCUE 07009 02/24/2007 07-0018441 K 1 Person/Entity Tnvclved I ___J I I - 1 I Local Option Business name (if applicable) Area Code Phone Number 0 Check This Box if L_J L___ I I same address as Mr.,Ms., Mrs. First Name MI Last Name Suffix incident location. I I I l___J Then skip the three duplicate address (Number I Prefix Street or Highway Street Type Suffix lines. I 1 I I I -__J Post Office Box Apt./Suite/Room City I II - I-I I i State Zip Code More people involved? Check this box and attach Supplemental Forms (NFIRS-1S) as necessary K2 Owner 0 Same as person involved? Then check this box and skip 1 I I I - The rest of this section. Local Option Business name (if Applicable) Area Code Phone Number I I I I I I L- I I I ElCheck this box if Mr.,Ms., Mrs. First Name MI Last Name Suffix same address as II incident location. I I i 1 1 __J Then skip the three duplicate address Number Prefix Street or Highway Street Type Suffix lines. I 1 I 1 I ._____..1 6 Post Office Box Apt./Suite/Room City III I-I J . State Zip Code L Remarks Local Option Twig on fire in a power line. Mid-American got the line clear. , L Authorization I FROST,J 1 1 Frost, John I ILT I I I LO_LI 1251 I 20071 Officer in charge ID Signature Position or rank Assignment Month Day Year Box if© 1 FROST,J I 'Frost, John I ILT I I I I 02I 125I 20071 same ki report ID Signature Position or rank Assignment Month Day Year Member making as officerg p g • in charge. FIRE RESCUE 07009 02/24/2007 07-0018441 A MM DD YYYY ❑Delete NFIRS -1 107009 1 IA I 02 I 1241 I 2007 1 14 I 107-0018407 1 1 000.1 [1]Change Basic FDZD * State* Incident Date * Station Incident Number Exposure * ❑No Activity uMl„ Aei„ni,SilecVx7n B oA1 eer nia„taivie Lo'-awtlo.'n ape cif „ iorn i„cU„se on„ly.,f,o uwu l„dn ani„ f.ic„ „„ ri,r Census Tract I0004 I_Ln B Location* _Street address ., ® I 5221 1 I (Evergreen ) 1 IAVE . 1 LJ ❑Intersection Number/Mile ost Prefix P Street or Highway Street Type Suffix ❑In front of ®Rear of I )Waterloo I IIA 1 150703 I-L- 1 Apt./Suite/Room City State Zip Code ❑Adjacent to 1 ❑Directions Cross street or directions, as applicable L I g ) }.,�> , Secondary Address C Incident Type * El Date & Times Midnight is 0000 E2 Shift & AlarmT 1444 1 (Power line down I Check boxes if Month Day Year Hr Min Sec Local Option dates are the Incident Type same as Alarm ALARM always required IC 1 I 0 11 Aid Given or Received* Date. Alarm * 1 021 1 241 L 20071120:05:00 I 4 py Shift or Alarms District 1J Platoon ARRIVAL required, unless canceled or did not arrive 1 ❑Mutual aid received ( I` ❑ Arrival * 1 021 1 241 [ 20071120:10:00 I 2 ❑Automatic aid recv. Their FDZD 17h3 State CONTROLLED Optional, Except for wildland fires Special Studies) 3 ❑Mutual aid given p 4 Automatic aid given 1 ❑Controlled I 021 I 241 I 20071120:20:00 I Local Option 5 ❑Other aid given Their LAST UNIT CLEARED, required except for wildland fires 1 1 1 Incident Number Last Unit Special Special N ®None CI Cleared 1 021 1 2411 20071120:20:00 I study ID# Study Value F Actions Taken * G1 Resources * G2 Estimated Dollar Losses & Values CogCheck this box and skip this section if an Apparatus or LOSSES: Required for all fires if known. Optional for non fires. Personnel form is used. None 186 1 !InvestigateI Primary Action Taken (1) Apparatus Personnel Property $1 1 , 1 0001,1 0001 ❑ Suppression I I I I Contents $1 I , 1 0001;1 0001 ❑ I II _I Additional Additional Action Taken (2) EMS 1 I I 1 PRE-INCIDENT VALUE: optional 1 1 1 Other 1 000111 00031 Property $1 I , I 0001,1 009] ❑ Additional Action Taken (3) ❑ Check box if resource counts include aid received resources. Contents $1 1 , 1 0001,1 000I CI Completed Modules H1*Casualties❑None H3 Hazardous Materials Release I Mixed Use Property ❑Fire-2 Deaths Injuries N EI None NN X Not Mixed 1 0 Assembly use ❑Structure-3 Fire I I 1 1 ❑Natural Gas: slow leak, no evauation or Ha:Mat actions 20 —Education use service❑Civil Fire Cas.-4 2 ❑Propane gas: <zl lb. tank as in home eBQ grill) 33 Medical use Gasoline: vehicle fuel tank cResidential use ®Fire Serv. Caa.-5 I II I ❑ 4 0 Civilian 3 =portable container ❑EMS-6 5 1 Row of stores H2 Detector 4 ❑Kerosene: fuel burning equipment or portable storage 53 —Enclosed mall ❑HazMat-7 5 Required for Confined Fires. fuel/fuel['Dieseloil:vehicle fuel tank or portable ❑Di l 58 —Bus. & Residential ❑Wildland Fire-8 1111netector alerted occupants 6 ❑Household solvents: home/office spill, cleanup only 59 Office use ❑X Apparatus-960 a�Industrial use 7 ❑Motor oil: from engine or portable container ®Personnel-l0 2❑netector did not alert them ❑ paint naps totaling< 55 gallons 63 Military use 8 Paint: from ❑Arson-11 jJ Unknown 65 my Farm use ❑ 0 ❑Other: special Ha=Mat actions required or spill a s5gal., 00 ®Other mixed use Please complete the HazMat form 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 16 1 ❑Restaurant or cafeteria 41 9� :1-or 2-family dwelling 599 LiBusiness office 162 ❑Bar/Tavern or nightclub 429❑Multi-family dwelling 615 ❑Electric generating plant 21.3 ❑Elementary school or kindergarten 43 9❑Rooming/boarding house 629 ❑Laboratory/science lab 215 ❑High school or junior high 449❑Commercial hotel or motel 700 ['Manufacturing plant' 24 1 ❑College, adult education 459❑Residential, board and care .819 ❑Livestock/poultry storage(barn) 311 ❑Care facility for the aged 464❑Dormitory/barracics 882 ❑Non-residential parking garage 331. ❑Hospital 519❑Food and beverage sales 891 0 Warehouse Outside 936 ❑'vacant lot 98 1 ❑ 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 669 Forest (timberland) Lookup and enter a Property Use code only if ❑ 951 ❑Railroad right of way you have NOT checked a Property Use box: 807 ❑Outdoor storage area 960 ❑Other street Property Use 1419 I 919 ❑Dump or sanitary landfill 961 ❑:Highway/divided highway 931 ❑Open land or field 962 ❑Residential street/driveway 11 or 2 family dwelling NFIRS-1 Revision 06/03/05 FIRE RESCUE 07009 02/24/2007 07-0018407 K 1 Person/Entity Involved I. I I I - I I-I Local Option Business name (if applicable) Area Code Phone Number ❑Check This Box if same address as Mr.,Ms., Mrs. First Name MI Last Name Suffix incident location. I I I I Then skip the three U duplicate address Number Prefix Street or Highway Street Type Suffix lines. I I I I I _J Post Office Box Apt./Suite/Room City I I I J-I I State Zip Code More people involved? Check this box and attach Supplemental Forms (NFIRS-1S) as necessary K2 Owner 0 Same as person involved? Then check this box and skip ( _� I I - I I" The rest of this section. _-J Local Option Business name (if Applicable) Area Code Phone Number L __1 I 1 ❑ Check this box if Mr.,Ms., Mrs. First Name MI Last Name Suffix same address as incident location. ( I II L.�'' I -� I I )Then skip the three duplicate address Number Prefix Street or Highway I Street Type Suffix lines. I I ( J I I ! Post Office Box Apt./Suite/Room City uI I-I I State Zip Code L Remarks Local Option Respond to a report of a power line down. Arrived on scene and investigated to find a power entrance cable to the residence down across the alley. Isolate area with street dept. barricades. Notified Mid-American Energy of the situation. 1 1 L Authorization I FRESHWATER,M I ' Freshwater, Marty I ILT I 1304 I I 02 1124I 1 20071 Officer in charge ID Signature Position or rank Assignment Month Day Year sh Cl f ® I FRESHWATER,M I I Freshwater, Marty I ILT 11 304 I I 021 124I I 20071 same Position or rank Assignment Month Day Year as Officer Member making report ID Signature in charge. . FIRE RESCUE 07009 02/24/2007 07-0018407 MM DD YYYY ®Delete NFIRS -1 107009 I IIA I 102 1 1241 I 2007 I 16 1 1 07-0018131 I I 0001 ❑Change Basic FDID State Incident Date Station Incident Number * Exposure LINO Activity ' I".e�.. .,, u�.c w , ,�a�� r„at me euu,e a .c„ 'n,n ,,,riuei,� ,n y,�v,�ea-cm-tne .rrm.a,,,r-ri,e Census Tract 0013 ®2 • Location* IJ Module`In�Seci.ion B uAlternative Location specification". Use only for Wildland fires. 1 1-L I a En Street address 1 002251 Iw I I-RIDGEWAY ®� I I ['Intersection Number/Milepost Prefix Street or Highway Street Type Suffix ❑In front of �g El Rear of 'WATERLOO 1 1 IA 1 L'0 7 01 I- 1 Apt./Suite/Room City State Zip Code ['Adjacent to I ❑Directions Cross street or directions, as applicable f,, Y tr. Secondary Address .740 Un -t- , , . c El Date & Times Midnight is 0000 Incid nt T e �c E2 Shift & Alarmr I 1 1 intentional transmission of I Check boxes if Local Option l dates are the Month Day Year Hr Min Sec Incident Type same as Alarm ALARM always required IC I I 014 L Date. D Aid Given or Received Alarm I 021 1 241 I 20071109:47:111 Shift or Alarms District Platoon ARRIVAL required, unless canceled or did not arrive 1 ❑Mutual aid received 1 IU ® Arrival I 021 1 241 1 20071109:52:00 Z3 2 ['Automatic aid recv. Their FOLD Their State CONTROLLED Optional, Except for wildland fires Special Studies) 3 ®Mutual aid given 4 ®Automatic aid given 1 � El Controlled I 021 I 241 I 2007I10 9:557:0 Q I Local Option 5 ❑Other aid given Their LAST UNIT CLEARED, required except for wildland fires I I L_. Incident Number Last: Unit Special Special N ®None ® I 021 1 241 I 20071109:57:00 1 study ID# Study Value Cleared F. Actions Taken* Gl Resources * G2 Estimated Dollar Losses & Values IDCheck this box and skip this section if an Apparatus or LOSSES: Required for all fires if known. Optional 186 I Investigate _I Personnel form is used. for non fires. None Apparatus Personnel Property $1 I , I 0001,1 000I ❑ Primary Action Taken (1) Suppression I I I I Contents $1 I , I 0001,I 000J ❑ I I I ---I EMS 1 Additional Action Taken (2) PRE-INCIDENT VALUE: Optional I I I I Other 1 00011 I 00031 Property $1 1 , 1 0001,1 0001 ❑ Additional Action Taken (3) ❑ Check box if resource counts include aid received resources. Contents $1 1 , 1 0001,1 000�I � Completed Modules H1*Casualties0None H3 Hazardous Materials Release I Mixed Use Property 0 Fire-2 Deaths Injuries N n None EN X Not Mixed 10 Assembly use ❑ Fire Structure-3 1 I ( 1 1 ❑Natural Gas: also leak, no evauation or Ha5Mat actions Service 20 —Education use['Civil Fire Cas.-4 2 ['Propane gas: <21 lb. tank (as in Home BBC) grill) 3 3 Medical use ® ❑Fire Serv. Cas.-5 civilian' I I 1 3 ❑Gasoline: vehicle fuel tank or portable container 40 Residential use ❑EMS-6 4 lJ f-1 51 Row of stores H2 Detector Kerosene: fuel burning equipment or portable storeys 53 —Enclosed mall 0HazMat-7 Required for Confined Fires. 5 []Diesel fuel/fuel oil:vehicle fuel tank or portable 58 ®Bus. & Residential Wildland Fire-8 6 []Household solvents: home/office spill, cleanup only 59 ..Office Office use 1❑Detector alerted occupants 60 O Apparatus-9 7 ❑Motor oil: from engine or portable container Industrial use —Military use Personnel-10 20Detector did not alert them 8 ❑Paint: from paint cans totaling< 55 gallons 65 :®Farm use ❑Arson-11 U unknown Lor❑ 0 ❑Other: special HarMac actions requires spill says'., QQ Other mixed use Please complete the HazMat form — j Property Use* Structures 3410 Clinic,clinic type infirmary 539 ❑Household goods,sales,repairs 342❑Doctor/dentist office 579 ❑Motor vehicle/boat sales/repair 131 ❑Church, place of worship 36 1❑Prison or jail, not juvenile 571 ❑Gas or service station 161 ❑Restaurant or cafeteria 4 19❑ 1-or 2-family dwelling 599 El Business office 162 ❑Bar/Tavern or nightclub 429III 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 700111 Manufacturing plant 241 ❑College, adult education 459❑Residential, board and care 819 ❑Livestock/poultry storage(barn) 311 ❑Care facility for the aged 4 64❑Dormitory/barracks 882 ❑Non-residential parking garage 33 1 ❑Hospital 5 19❑Food and beverage sales 891 0 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 669 Forest (timberland) Lookup and enter a Property Use code only if ❑ 951 ['Railroad right of way you have NOT checked a Property Use box: 807 ['Outdoor storage area 960 ❑Other street Property Use 1429 I 919 ❑Dump or sanitary landfill 961 ❑Highway/divided highway 1 931 ❑open land or field 962 ❑Residential street/driveway 'Multifamily dwelling NFIRS-1 Revision 06/03/05 FIRE RESCUE 07009 02/24/2007 07-0018131 K1 Person/Entity Involved 'Ridgeway Towers I I I - I I-I I Local Option Business name (if applicable) Area Code Phone Number l I L I I-J I I II ®Check This Box if Mr.,Ms., Mrs. First Name MI Last Name Suffix same address as incident location.Then skip the three 100225 I IW I 'RIDGEWAY AV I I I L_J duplicate address Number Prefix Street or Highway Street Type Suffix lines. I I I I (WATERLOO Post Office Box Apt./Suite/Room City IIA I 150701 1 I I State Zip Code ®More people involved? Check this box and attach Supplemental Forms (NFIRS-1S) as necessary Owner Same as`person involved? e� �ID ����®� v �� Then check this box and skip.' JI L .J - I ' I_ I The rest of this section. Local Option Business name (if Applicable) Area Code Phone Number I I I II_II 1 L1 ❑ Check this box if Mr.,Ms., Mrs. First Name MI Last Name Suffix same address as incident location. I 'I u I I ' I I. ' Then skip the three duplicate address Number Prefix Street or Highway Street Type Suffix lines. I I I I I Post Office Box Apt./Suite/Room City III J-I I State zip Code L Remarks Local Option Notifier response. Alarm activated by power outage due to winter storm. . I j } L Authorization IMOORE,M I 'Moore, Michael I ILT I 1306 I I 021 1 241 I 2007, 1 1 Officer in charge ID Signature Position or rank Assignment Month Day Year Check Box IMOORE,M 1 'Moore, Michael I ILT I I306 _I [ 021 124I I 20071 same Position or rank Assignment Month Day Year as Officer Member making report ID Signature in charge. FIRE RESCUE 07009 02/24/2007 07-0018131 AMN DD YYYY ❑Delete NFIRS -1 107009 I IA 1 02 1 1 241 1 2007 I 11 1 1 07-0018138 1 1 0001 0 FDID State Incident Date E Change BasicStation Incident Number Exposure ❑No Activity 'NOdul 'n „Ctrrt a a-d..c a„av „< auu,: a �, r.,r., .n,'", ..,,,, y.ivvuc.,'d„ ,.,, 7,au,a„u,aye Census Tract ®QQ3 _ ®Q BLocation* LJ Module In�Sectlon B"Al terns[ivevLocationy5pecification°.u0se only for Wildlandef Tres. Street address I I 004161 I I 'ALLE;N 1 1ST 1 L___J ❑Intersection Number/Milepost Prefix Street or Highway Street Type Suffix ❑In front of ®Rear of I 'WATERLOO 1 I IA 1 [5 07 0 3 ]-1 1 Apt./Suite/Room City State Zip Code ['Adjacent to 1 ❑Directions or Cross street directions, as applicable I _ 1 LW i,e9 i Secondary Address IncidentType * Midnight is 0000 El Date & Times E2 Shift & Alarm 1 444 1 1Power line down 1 Check boxes if Month Day Year Hr Min Sec Local Option dates are the Incident Type , same as Alarm ALARM always required 1 1 Date. D Aid Given or Received* Alarm * 1 IC' 1 ( Q 1 021 I. 241 I 20071110:16:23 1 Shift or Alarms District Platoon , ARRIVAL required, unless canceled or did not arrive 1 ['Mutual aid received 1 11 1 ® L_ i I241 I 11 I �3 Arrival * 022007 10:28:00 2 11jAutomatic aid recv. Their FDID Their State CONTROLLED Optional, Except for wildland fires Special Studies) 3 ['Mutual aid given 4 Automatic aid given 1 1 ®Controlled 1 021 I 241 1 20071110:44:00 1 Local Option 5 []Other aid given Their LAST UNIT CLEARED, required except for wildland fires ( 1 I Incident Number Last Unit Special Special N ®None ® Cleared 1 021 1 2411 20071110:44:00 1 study ID$ Study Value F Actions Taken * G1 Resources * G2 Estimated Dollar Losses & Values ® Check this box and skip this LOSSES: Required for all fires if known. Optional section if an Apparatus or for non fires. 186 I 'Investigate 1 Personnel form is used. None Prima ry Action Taken (1) Apparatus Personnel property $1 1 , 1 0001,1 0001 ❑ Suppression I 1 1 I Contents $1 1 , 1 0001,1 000J ❑ 1 II Additional Action Taken (2) EMS I 1 1 1 PRE-INCIDENT VALUE: optional I I I _I Other I 000111 00031 Property $I 1 , 1 0001 ,1 0001 ❑ Additional Action Taken (3) El Check box if resource counts {q� El include aid received resources. Contents $1 1 , 1 0001,1 0(1 Completed Modules }I1*Casualties[]None H3 Hazardous Materials Release I Mixed Use Property ❑Fire-2 Deaths Injuries N .]None NN X Not Mixed 10 Assembly use ❑Structure-3 Fire 1 ( j 1 []Natural Gas: slew leak, no evanation or Ha:Mat actions 2© Education use Service ®Civil Fire Cas.-4 2 []Propane gas: <21 lb. tank (as in home HBO grill) 33 Medical use ❑Fire Serv. Cas.-5 -'Residential use Civilian) i I 1 3 ❑Ga901ine: vehicle fuel tank or portable container 40 ❑EMS-6 4 []Kerosene: 51 -'Row of stores H2�, fuel burning equipment or portable storage 53 ®Enclosed mall Detector ❑HazMat-7 5 Diesel fuel/fuel il Required for Confined Fires. o :vehicle fuel tank or portable ❑ 58 —Bus. & Residential 1:1Wildland Fire-8 1❑Detector alerted occupants 6 []Household solvents: borne/office spill, cleanup only 59 Office use Li Apparatus-960 Industrial use 7 []Motor oil: from engine or portable container 63 —Military use El Personnel-10 2®Detector did not alert them 8 []Paint: from paint cane totaling< 55 gallons 65 Farm use ❑Arson-11 jJ ❑Unknown 0 []Other: special HazMat actions required or spill a 55ga1., 00 —Other mixed use Please complete the HacHet form — 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 3 6 1❑Prison or not jail, juvenile571 ['Gas or service station 161 ❑Restaurant or cafeteria 4 19 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 ['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 98 1 ❑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 669 Forest (timberland) Lookup and enter a Property Use code only if ❑ 951 ['Railroad right of way you have NOT checked a Property Use box: 807 [Outdoor storage area 960 street ['Other Property Use 1419 1 919 ❑Dump or sanitary landfill 961 ['Highway/divided highway 931 ❑Open land or field 962 ❑Residential street/driveway 11 or 2 family dwelling 1 NFIRS-1 Revision 06/03/05 FIRE RESCUE 07009 02/24/2007 07-0018138 11(1 Person/Entity Involved I I I I - I I L______J Local Option business name (if applicable) Area Code Phone Number L_J I I L.-J ❑Check This Hox if Mr.,Ms., Mrs. First Name MI Last Name Suffix j same address as I incident location. Then skip the three I I [ I I L I I I ___J duplicate address Number prefix Street or Highway Street Type Suffix lines. I I I I I I Post Office Box Apt./Suite/Room City III _J-I _J I State Zip Code LIMore people involved? Check this box and attach Supplemental Forms (NFIRS-1S) as necessary 2 Owner ❑ Same as person involved? Then check this box and skip 1 I I I - I I-L __J The rest of this section. Local Option Business name (if Applicable) Area Code Phone Number I I I I I I I 1 I I ❑ Check this box if Mr.,Ms., Mrs. First Name MI Last Name Suffix same address as incident location. ( I I� .__J l i I I I I Then skip the three �_J duplicate address Number Prefix Street or Highway Street Type Suffix lines. Post Office Box Apt./Suite/Room City II I _I-I I State zip Code = L Remarks Local Option Called for wire down. On arrival found service line to residence was downed by a fallen tree due to icy weather conditions. Dispatch notified Mid American Energy and we advised resident not to approach the down wire. 1 L Authorization. 1 INADING,L I INading, Larry I ILT I 1301 1 I 021 1 241 I 20071' Officer in charge ID Signature..._ Position or rank Assignment Month Day Year Check ® I NADING,L 1 I Nading, Larry 1 ILT J 1301 1 1 02 1 1 241 1 2 002 same Position or rank Assignment Month DayYear , as Officer Member making report ID Signature S in charge. FIRE RESCUE . 07009 02/24/2007 07-0018138 . A MM DD YYYY ❑Delete NFIRS -1 107 00 9 1 ILAJ I 02I 1241 1 2007 I 14 I 107-0018139 1 1 0001 ❑change Basic FDID * State* Incident Date * Station Incident Number Exposure* Ex p * ❑No Activity Modulen section H`"Alternative`, a Yiuviueu du ue hiiu,auu r,Pe La' tionsspecification'. Use only for Wildland fires. Census TYaCt 0 0 1 5- —L_3 I B Location* _ (--6,„_ ®Street address I 039101 I I 'UNIVERSITY _1 IAV I L___J ❑Intersection Number/Milepost Prefix Street or Highway y Street Type suffix ❑In front of 5 ❑Rear of I I 'WATERLOO 1 IIAJ 150703 1-L—_____J Apt./Suite/Room City State Zip Code ❑Adj aCent to ❑Directions I 1 Cross street or directions, as applicable IWallgreens 1 r.-) t Secondary Address CEl Date Incident Type * Midnight is 0000 & Times E2 Shift & Alarm? 1745 1 'Alarm system activation, no I Check boxes if Month Day Year Hr Min Sec Local Option dates are the ��t,� Incident Type same as Alarm ALARM always required IC I I oil L Aid Given or Received* Date. Alarm * I 021 I 241 I 20071110:19:00 1 D Shift or Alarms District Platoon ARRIVAL required, unless canceled or did not arrive 1 ❑Mutual aid received IL 0 Arrival 1021 ' 2411 20071110:25:00 I E3 2 ©Automatic aid recv. Their FDID Their State CONTROLLED O Special Studies)3 Mutual aid given[' Optional, Except for wildland fires 4 Automatic aid given L I ❑Controlled 1 021 I 2411 20071110:28:00 I Local Option 5 ❑Other aid given Their LAST UNIT CLEARED, required except for wildland fires 1 I I N ®None Incident Number Last Unit Special Special ❑ Cleared I 021 I 241 1 20071110:28:00 1 study r05 Study Value F Actions Taken * G1 Resources * G2 Estimated Dollar Losses & Values IT Check this box and skip this LOSSES: Required for all fires if known. Optional L-( section if an Apparatus or for non fires. 186 1 'Investigate _I Personnel form is used. None Apparatus Personnel property $1 I ' I 0001,1 000 ❑ Primary Action Taken (1) Suppression I 000111 0003I Contents $I I , 1 0001,1 00J ❑ I I L® Additional Action Taken (2) EMS I I I I PRE-INCIDENT VALUE: optional II I Other I I I I Property $1 I , L 0001,1 000_1 ❑Additional Action Taken (3) ❑ Check box if resource counts ❑ include aid received resources. Contents $1 1 , 1 0001 ,1 0001 Completed Modules1*Casualties[]None E3 Hazardous Materials Release I Mixed Use Property 0Fire-2 Deaths Injuries N ENone NN X Not Mixed ❑Structure-3 Fire 10 Assembly use • I I I 1 ❑Natural Gas: glow leak, no evauation or Ha:Mar actions 20 Education use ❑Civil Fire Cas.-� Service 2 []Propane gas: e21 lb. tank (as in home aaQ grill) 33 Medical use Fire Serv. Cas.-5 or portable container Residential use Civilian! I I I 3 []Gasoline: vehicle feel tank 40 ❑EMS-6 4 [1 Kerosene: fuel burning equipment or portable storage 51 —Row of stores H2 Detector 53 Enclosed mall 0HazMat-7 Required for Confined Fires. 5 ❑Diesel fuel/fuel oil:vehicle fuel tank or portable 58 'Bus. & Residential ❑wildland Fire-8 ❑ 6 ❑Household solvents: home/offices i 1 Detector alerted occupants spill, cleanup only 59 Office use QApparatus-9 7 ❑Motor oil: from or60 Industrial use engine portable container 2 Detector did not alert them 63 —Military use ®Personnel-10 ❑ 8 ❑Paint: from paint cans totaling< 55 gallons 65 Farm use ❑Arson-11 V❑Unknown 0 []Other: special Ha:Mat actions required or spill , 55ga1., 00. Other mixed use Please complete the HazMat form 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 3610 Prison or jail, not juvenile 571 ❑Gas or service station 161 ❑Restaurant or cafeteria 419❑ 1-or 2-family dwelling 599 [1Business 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 ❑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 ❑Ncn-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 669 Forest (timberland) Lookup and enter a Property Use code only if 951 ❑Railroad right of way you have NOT checked a Property Use box: 807 ❑Outdoor storage area 960 Other street ❑ Property Use 1500 I 919 lijDump or sanitary landfill 961 0H3.ghway/divided highwayI 931 ❑Open land or field 962 ❑Residential street/driveway 'Mercantile, business, Other NFIRS-1 Revision 06/03/05 FIRE RESCUE 07009 02/24/2007 07-0018139 Ri Person/Entity Involved I I I I - I I-I J Local Option Business name (if applicable) Area Code Phone Number l� I I I I Check This Box if I Irs. I MI Last Name Suffix same address as Mr.,Ms., First Name incident location. I I I l� ) Then skip the three duplicate address INumber I Prefix l Street or Highway Street Type Suffix lines. I I I I I I Post Office Box Apt./Suite/Room City II I I-I I . State zip Code ®More people involved? Check this box and attach Supplemental Forms (NFIRS-1S) as necessary f Same as person involved? 2 Owner Then check this box and skip I I I I - I I I__ __I The rest of this section. Local Option Business name (if Applicable) Area Code Phone Number I I l IL JI II I DCheck this box if Mr.,Ms., Mrs. First Name I MI Last Name Suffix same address as I i I I I I I ( I: I incident location. , Then skip the three duplicate address Number Prefix Street or Highway Street Type Suffix lines. I I I I I Post Office Box Apt./Suite/Room City I I I _J-L I State Zip Code L Remarks Local Option Respond Code 1 to an activated fire alarm. Not needed. Power failure. i • E E e L Authorization 'FRESHWATER,M I ' Freshwater, Marty I ILT 1 1304 I I 021 1 241 1 _2007I Officer in charge ID Signature Position or rank Assignment Month Day Year Check ® I 1 l I I I 13041 1 I I I, Box if FRESHWATER, Freshwater, Marty LT 0212412007i same Position or rank Assignment Month Day Year as Officer Member making report ID Signature in charge. FIRE RESCUE 07009 02/24/2007 07-0018139 1 A MM DD YYYY ❑Delete 107009 j lIA I 102 1 124I ( 2007 f 13 I 107-0018151 1 1 000! HEIRS -1 FDID ❑Chan e* State* Incident Date * Exposure Station Incident Number g Basic ❑No Activity „'„ ai ..i�i , �,'ro:-ueu�„ Y.,. ..iau.'"' Census Tract 10026 1-L 4 1 B Location* u Module`In SeclLion H�uAl[ernative[Location,Speci ficatioR".LLOse only far wildland fires. t� ['Street address d ti 1 1 1 1 'BIG ROCK �.' f: 1 L _____J L x ® Number/Milepost Prefix Intersection Street or Highway Street Type Suffix pin front of ®Rear of I 1 (WATERLOO 1 1IA 1 150703 _1-I 1 Apt./Suite/Room City State Zip Code ['Adjacent to 1 Directions BURTON AV 1 Cross street or directions, as applicable Secondary Address Incident Type * Midnight is 0000 Ei Date & Times E2 Shift & AlarmT 1 444 1 !Power line down 1 Check boxes if Month Da Year Hr Min Sec Local Option Incident Type dates are the Y same as Alarm ALARM always required IC 1 I oat Li D Aid Given or Received* Date. Alarm * I 021 1 2411 20071110:54:561 Shift or Alarms District Platoon ARRIVAL required, unless canceled or did not arrive 1 C]Mlltual aid received ❑ I IL_J Arrival I 021 1 241 1 20071110:57:od 1 E3 2 Automatic aid reev. Their FDID Their State p P Special Studies) 3 [Mutual aid given CONTROLLED Optional, Except for wildland fires 4 [Automatic aid given I 1 ®Controlled 1 021 1 241 1 20071111:20:001 Local Option 5 []Other aid given Their LAST UNIT CLEARED, required except for wildland fires Incident Number Last Unit Special l N ❑None Cleared L 021 1 241 I 20071111:25:00 I study IO# Study Value F Actions Taken * G1 Resources * G2 Estimated Dollar Losses & Values ® Check this box and skip this LOSSES: Re ired for all fires if known. Optional section if an Apparatus orRequired J Personnel form is used. for non fires. None 86 1 'Investigate Apparatus Personnel Property $1 1 , 1 0001,1 000j E Primary Action Taken (1) Suppression 1 1 1 1 Contents 000 , 000 1 II .�1 $I lol I I I ❑ Additional Action Taken (2) EMS I I I 1 PRE-INCIDENT VALUE: Optional I I I Other 1 00011 I 00031 Property $I I . I 0001,1 000I ❑Additional Action Taken (3) ❑ Check box if resource counts include aid received resources. Contents $1 1 , 1 0001,I 0001 ❑ Completed Modules Hi*Casualties[None H3 Hazardous Materials Release I Mixed Use Property ❑Fire-2 Deaths Injuries N None NN N:Not Mixed ❑Structure-3 Fire 10 Assembly use I I I I 1 ❑Natural Gas: elow leak, no evaaation or HarMat actions 20 Education use ®Civil Fire Cas.-4 Service 2 ❑Propane gas: cil lb. tank (as in home BHP grill) 33 m Medical use ['Fire Serv. Cas.-5 Civilian[ I I 1 3 ❑Gasoline: vehicle fuel tank or portable container 40 —Residential use ®EMS-6 �� 5 1 Row of stores I�2 Detector 4 Kerosene: fuel burning equipment or portable storage ❑HazMat-7 53 Enclosed mallRequired for Confined Fires. 5 ❑Diesel fuel/fuel oil:vehicle fuel tank or portable 58 --Bus. & Residential [Wildland Fire-8 6 ❑Household solvents: home/office spill, cleanup onl 1 ODetector alerted occupants y 59 Office use ®Apparatus-9 7 [Motor oil: 60 Industrial use from engine or portable container 110Personnel-10 2[]Detector did not alert them 8 [paint: from 63 Military use paint cans totaling< 55 gallons ®Arson-11 65 ®Farm use Up Unknown 0 [Other: special Haeeeat actions required or spill > 55gal., 00 ®Other mixed use ,®> Please complete the HacMat form — J Property Use* Structures 341111Clinic,clinic type infirmary 539 ['Household goods,sales,repa:Lrs 342 0 Doctor/dentist office 579 l]Motor vehicle/boat sales/repair 131 ['church, place of worship 3 61❑Prison or jail, not juvenile 571 [Gas or service station 161 ❑Restaurant or cafeteria 4190 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 Laborator 215 Hi h school or ❑ y/science lab ❑ 4 junior high 449 Commercial hotel or motel 241 ®College, adult education ❑ !00 ['Manufacturing plant4 59[Residential, board and care 819 Livestock/poultry storage(barn) 311 [Care facility for the aged 464[Dormitory/barracks 882 [Non-residential parking garage 3 31. [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 669 [Forest (timberland) 951 ((''''�1Railroad right of wayLookup and enter a Property Use code only if LJ g you have NOT checked a Property Use box: 807 [Outdoor storage area 960 [Ot.her street Property Use 1963 1 919 [Dump or sanitary landfill 961 [Highway/divided highway 931 [Open land or field 962 [Residential street/driveway !Street or road in commercial I NFIRS-1 Revision 06/03/05 FIRE RESCUE 07009 02/24/2007 07-0018151 K1 Person/Entity Involved Local Option Business name (if applicable) � I - I I-I I pp Area Core Phone Number I I L_J I I U ®Check This eox if Mr.,Ms., Mrs. First Name MI Last Name Suffix same address as incident location. Then skip the three I '' II s` duplicate address I I�J I I I 1 u Number Prefix Street or Highway Street Type Suffix lines. I I I I I I Post Office Box p /Suite/Room A t. City L1 I I-I I State Zip Code LiMore people involved? Check this box and attach Supplemental Forms (NFIRS-1S) as necessary K2 Owner 0 Same as person involved? , Then check this box and skip I I I I I (_1_________J The rest of this section. Local Option Business name (if Applicable) Area Code Phone Number I I I I I___I I 1 I I ® Check this box if Mr.,Ms., Mrs. First Name MI Last Name Suffix same address as incident location. Then skip the three u duplicate address Number Prefix Street or Highway Street Type Suffix lines. I I I I I I Post Office Box Apt./Suite/Room City L_____J I .-J- 1 I State Zip Code L Remarks x_ Local Option 303 called to Burton and Big Rock for report of power lines down. PD on scene advise to block @ Dunkerton rd. The main high voltage lines are down along with several broken poles. 10-8 @ 11:25 Lt. J Ruehs L Authorization IRUEHS,J I IRuehs, Jeff I ILT I I 303 I I 021 124I I 20071 Officer in charge ID Signature Position or rank Assignment Month Day Year Chec same]{ ® ( I I I I I I I I I I I Box if RUEHS,J Ruehs, Jeff LT 303 02 24 200711 as Officer Member making report ID Signature Position or rank Assignment Month Day Year in charge. 1 { FIRE RESCUE 07009 02/24/2007 07-0018151 j A MM DD YYYY ❑Delete NFIRS -1 107009 1 IIA I 1 02 1 1 241 1 2007 1 16 1 107-0018172 1 I 000I 0change Basic FDID * State* Incident Date * Station Incident Number * Exposure ®No Activity ci,e... ,.... ........a... ...e....e aaa. ... ....5 .....t .. ... . Census Tract 0011 - 00 BLocation* Module Insect ion H "Alternative Location Specification". Use only' for wildland fires. ®^"N pn Street address 1 009021 1 I 'VERMONT '" d,,-, 1 1ST I I I ❑Intersection Number/Milepost Prefix Street or Highway Street Type Suffix ❑In front of 1 I I ( I-�� ❑Rearr of IA I 1 [WATERLOO 50702 Apt./Suite/Room City State Zip Code ®Adjacent to 1 ❑Directions Cross street or directions, as applicable II ,,,;)1) e Secondary Address �+ Incident Type .* Midnight is 0000 El Date & Times E2 Shift & AlarmT 600 I 'Good intent call, Other 1 Check boxes if Month Da Year Hr Min Sec Local Option dates are the Y IC I I 011 L Incident Type ,same as Alarm ALARM always required Aid Given or Received* Date. Alarm * I 021 1 241 I 20071111:49:351 DShift or Alarms District Platoon ARRIVAL required, unless canceled or did not arrive 1 ❑Mutual aid received I IL Arrival 021 1 241 1 20071111:58:00 1 E3 2 ❑Alltomat iC aid recv. Their FDID Their State CONTROLLED O 3 ❑Mutual aid given ptional, Except for wildland fires Special Studies 4 ®Automatic aid given 1 1 MControlled 1 0A I 241 I 20071112:01:00 1 Local Option 5 ['Other aid given Their LAST UNIT CLEARED, required except for wildland fires I I Incident Number Last Unit N None El Cleared1 021 1 241 I 20071112:01:00 1 study a1D1 l Special F Actions Taken * Gi Resources * G2 Estimated Dollar Losses & Values ® Check this box and skip this LOSSES: Required for all fires if known. Optional section if an Apparatus or Personnel form is used. for non fires. 186 1 'Investigate None Apparatus Personnel Property , 0001,1 000] CIPrimary Action Taken (1) $1 1 Suppression I I I I Contents $1 1 , 1 0001 ,1 000] ❑ Additional Action ction Taken (2) EMS I 11 1 PRE-INCIDENT VALUE: Optional I 1 I _1 Other I 00011 I 00031 Property $1 1 , 1 0001,1 00 ] ❑ Additional Action Taken (3) ❑ Check box if resource counts yj�� include aid received resources. Contents $1 1 , 1 0001 ,1 000] ❑ Completed Modules Hi*Casualties❑None ZH3 Hazardous Materials Release I Mixed Use Property ❑Fire-2 Deaths Injuries N Ei None NN X Not Mixed Fire 10 Assembly use Structure-3 slow leak, no evsaation or HazMat actions 20 Education use 1 ❑Natural Gas: ❑Cavil Fire Cas.-4 Service I 1 L— 19Pro Propanegas: ❑ P .21 lb. tank (as in home aso grill) 33 Medical use ❑Fire Serv. Cas.-5 civilian) I 1 1 3 ❑Gasoline: vehicle fuel tank or portable container 40 —Residential use 0 EMS-6 5 1 Row of stores I Detector 4 ❑Kerosene: fuel burning equipment or portable storage ®HazMat-7 112 53 Enclosed mall Required for Confined Fires. 5 ❑Diesel fuel/fuel Oil:vehicle fuel tank or portable 58 —Bus. & Residential ❑wildland Fire-8 11—YDetector alerted occupants 6 ['Household solvents: home/office spill, cleanup only 59 _Office use Apparatus-9 LJ 7 ['Motor oil: from engine or portable container 60 ®Industrial use ® 8 Cl Personnel-10 2®Detector did not alert them 63 —Military use Paint: from paint cans totaling< 55 gallons 65 m Farm use ❑Arson-11 U❑Unknown 0 ❑Other: Special HazMat actions required or spill > 55gal., 00 e�Other mixed use Please complete the HazMat form —. tj' 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 57 1 ❑ Gas or service station 161 ❑Restaurant or cafeteria 4 lg 1-or ❑ 2-family dwelling 5 99 El Business office 162 ❑Bar/Tavern or nightclub 429❑Multi-family dwelling 6 15 ❑Electric generating plant 213 ri Elementary school or kindergarten 439❑Rooming/boarding house 629 ❑Laboratory/science lab 215 ['High school or junior high 449❑Commercial hotel or motel 700 ['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 ❑Nou-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 669 Forest (timberland) Lookup and enter a Property Use code only if ❑ 951 ❑Rai.lroad right of way you have NOT checked a Property Use box: 807 ['Outdoor storage area 960 ❑Other street Property Use [962 1 919 ❑Dump or sanitary landfill 961 ❑Highway/divided highway 931 ❑Open land or field 962 plesidential street/driveway 'Residential street, road or NFIRS-1 Revision 06/03/05 FIRE RESCUE 07009 02/24/2007 07-0018172 i[(1 Person/Entity Involved ( I I ) ___J Local Option Business name (if applicable) Area Code Phone Number El I I I I L__ I I J u Check This Box if Mr.,Ms., Mrs. First Name same address as MI Last Name Suffix incident location. Then skip the three I I I I I I I 1_.J duplicate address Number Prefix Street or Highway Street Type Suffix i i i Post Office Box Apt./Suite/Room City L__I I I-I I State Zip Code ❑More people involved? Check this box and attach Supplemental Forms (NFIRS-1S) as necessary o -- K2 Owner ❑ Same as person involved? rs Then check this box and skip I I I I - I I I _----1 The rest of this section. Local Option Business name (if Applicable) Area Code Phone Number 1 I I I L___l I I L____I Check this box if Mr.,MS., Mrs. First Name same address as MI Last Name Suffix incident location. I I I L_JI I I I u Then skip the three duplicate address Number Prefix Street or Highway lines. Street Type Suffix ' I I I I I Post Office Box Apt./Suite/Room City L-J I I-I I State Zip Code -- ^----.m. L Remarks Local Option Responded to a report of power lines down. On arrival found cable tv wire that had broken loose from house. Advised owner to call cable company. I j . �__,_ ..._._ —- - gym._— ,-.... L Authorization IMOORE,M I (Moore, Michael I ILT I 1306 I 1 021 124I I 20071 Position or rank Assignment Month Day. Year Officer in charge ID Signature Check Box if® I MOORE,M I (Moore, Michael same I ILT I 1306 I ( 02 I I 24 1120071 as Officer Member making report ID Signature Position or rank Assignment Month Day Year in charge. FIRE RESCUE 07009 02/24/2007 07-0018172 1 MM DD YYYY NFIR.S -1 I — Delete 07009 1 A I 02 1 1 241 L 2007J 18 I 1 07-0018196 I I 000 1 ❑Change Basic FDID * State* Incident Date * Station Incident Number Exposure* Ex p * ®No Activity ter 7,nAAltee ai 'jL e > ' Census Tract 10010 00 J B Location* L�Moanle`Inysection B " lnative ocacion 5pecification`jUUse onlyv forUwi ldlande firesla,m fO 1KIStreet address �f 1 01441I L 11GLENNY I [AV I l 1 ['Intersection Number/Milepost Prefix Street or Highway Street Type Suffix ['In Re front of 0 Rear of I I [Waterloo I [IA I 150702 1-1 _J Apt./Suite/Room City State Zip Code ❑Adjacent to ❑Directions I ._I Cross street or directions, as applicable L e _ 11 � k1 Secondary Address Incident Type * Midnight is 0000 cT yp El Date & Times E2 Shift & Alarm 1600 1 'Good intent call, Other l Check boxes th ife Month Day Year Hr Min Sec Local Option Incident Type dates same as Alarm ALARM always required lc 1 [ 011 18 Aid Given or Received Date. Alarm * I 021 1 241 1 20071112:52:02 1 L * Shift or .Alarms District Platoon II ARRIVAL required, unless canceled or did not arrive 1 DMutual aid received I II J ® Arrival * 1 OA I 241 I 20071112:57:00 1 '3 2 ❑Automatic aid recv. Their FDID Their State CONTROLLED Optional, Except for wildland fires Special Studies' 3 ['Mutual aid given 4 ®Automatic aid given I j ®Controlled I 021 I 241 I 20071113:08:00 . Local Option 5 ❑Other aid given Their LAST UNIT CLEARED, required except for wildland fires I __I L=. Incident Number Last Unit Special Special N ®None ® Cleared I 021 I 241 I 20071113:08:00 1 study IOU Study Value pi Actions Taken * G1 Resources * G2 Estimated Dollar Losses & Values ® Check this box and skip this LOSSES: Required for all fires if known. Optional section if an Apparatus or for non fires. 186 I 'Investigate I Personnel form is used. None Apparatus Personnel Property $1 1 , 1 0001,1 0001 ❑ Primary Action Taken (1) Suppression I I I I Contents $1 1 , 1 0 001,1 0001 II I El Additional Action Taken (2) EMS ' I1 I PRE-INCIDENT VALUE: optional I I I I Other 1 00011 I 00031 Property $1 I , I 0001,1 000" ❑ Additional Action Taken (3) ❑ Check box if resource counts include aid received resources. Contents $1 I , I 0001,I 000" Completed Modules Hl*Casualties❑None H3 Hazardous Materials Release I Mixed Use Property ['Fire-2 Deaths Injuries N El None NN X Not Mixed 10 Assembly use 111Structure-3 Fire 1 ❑Natural Gas: slow leak, no evanation or Ha=Mat actions 20 Education use Service I II j 2['Civil Fire Cas.-4 3 ❑Propane gas: c21 lb. tank (as in home BBQ grill) 33 Medical use ['Fire Serv. Cas.-5 Civilian' I 1 I ['Gasoline: vehicle fuel tank or portable container 40 Residential use 51 ° ❑EMS-6 Row cif stores H2 4 C]Kerosene: fuel burning equipment or portable storage 53 Enclosed mall ['HazMat-7 Required for Confined Fires. 5 ['Diesel fuel/fuel Oil:vehlcle foal tank or portable 58 ' Bus. & Residential ❑Wildland Fire-8 1®Detector alerted occupants 6 ❑Household solvents: home/office spill, cleanup only 59 Office use U Apparatus-9 7 ❑ 60 —Industrial use Motor oil: from engine or portable container 0Personnel-10 20netector did not alert them 8 ❑Paint: from paint enne totaling < 55 gallons 63 Military use 65 —Farm use 0Arson-11 U❑unkuowa 0 ❑Other: Special HazMat actions required or spill > 55gal., 00 —Other mixed use v _ Please complete the HazMat form J Property Use* Structures 341❑Clinic,clinic type infirmary 539 ['Household goods,sales,repairs 342 L_IDoctor/dentist office 579 ['Motor vehicle/boat sales/repair 13 1 DChurch, place of worship 3 6 1❑Prison or jail, not juvenile 571 ['Gas or service station 161 ❑Restaurant or cafeteria 4 19 E) 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 62 9 ❑Laboratory/science lab 215 ['High school or junior high 449['Commercial hotel or motel 700 ['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 0 Industrial plant yard 655 ['Crops or orchard 946 ['Lake, river, stream 669 Forest (timberland) 951 DRailroad right of wayLookup and enter a Property Use csde only if ❑ g you have NOT checked a Property Use box: 807 ['Outdoor storage area 960 Other street ❑ Property Use 1419 I 919 ['Dump or sanitary landfill 961 ['Highway/divided highway 931 ❑Open land or field 962 ❑Residential street/driveway 11 or 2 family dwelling I NFIRS-1 Revision 06/03/05 FIRE RESCUE - 07009 02/24/2007 07-0018196 K1 Rorscn/Entity Involved I I I I - I I -I _J Local Option Business name (if applicable) Area Code Phone Number 1 I I I I II I I I I ®Check add ThiresHs as ox sif Mr.,Ms., Mrs. First Name MI Last Name Suffix same incident location. I I 1 , Then skip the three U duplicate address Number . Prefix Street or Highway Street Type Suffix lines. `J Post Office.Box Apt./Suite/Room City I I I-L_ J s State Zip Code s lJ rI More people involved? Check this box and attach. Supplemental Forms (NFIRS-1S) as necessary K2 Owner El Same as person involved? _ f Then check this box and skip I I I I - I i I I The rest of this section. Local Option Business name (if Applicable) Area Code Phone Number I I I I I I I I I I ❑ Check this box if Mr.,Ms., Mrs. First Name MI Last Name Suffix same address as I incident location. I I I l ( I I I I I—J Then skip the three duplicate address Number Prefix Street or Highway Street Type Suffix lines. I I I I I J Post Office Box Apt./Suite/Room City I _I I J-L_ J - State Zip Code L Remarks Local Option Code 1 response to CO detector alarm. Investigated low battery in the detector and advised. 1 { 1 I j 1 L Authorization 'FROST,J I ' Frost, John I ILT I I I I 021 124I I 20071 Officer in charge ID Signature Position or rank Assignment Month Day Year Check I ILT I I _�J [ 02I 1241 I 20071 Box if® ( FROST,J ( I Frost, John same Position or rank Assignment Month Day Year as Officer Member making report ID Signature in charge. FIRE RESCUE 07009 02/24/2007 07-0018196 IA MM DD YYYY Li Delete NFIRS -1 107009 1 1..A_I 1 02 I 1 24j I 2007] 15 1 107-0018202 I I 0001 ❑Change Basic FDID * State* Incident Date * Station Incident Number * Exposure * ®No Activity B Module In Section B "Alternative Location Specification". Use only for Wildiand fires. 311e Census Tract 10 U 18 (_1®® Location* Module Street address '- ❑ I 1 I I (INDEPENDENCE Cam" 1 1AV I LJ ®Intersection Number/Milepost Prefix P Street or Highway Street Type Suffix ❑in front of ®Rear of I I L!ATERLOO I (IA 1 150703 1-L®_J Apt./Suite/Room City State Zip Code ❑Adjacent to Directions I Nevada ST Cross street or directions, as applicable Secondary Address Incident Type * Midnight is 0000 , Shift & AlarmT (`' yp El Date & Times �;2 I 815 1 (Severe weather or natural I Check boxes if Month Day Year Hr Min Sec Local Option dates are the Incident Type same as Alarm ALARM always required IC 1 I U 1 Date.D 0 l Aarm * I2 24 13:03:39 .-1 l Aid Given or Received*. I 2007 I Shift or Alarms District Platoon ARRIVAL required, unless canceled or did not arrive 1 ❑Mutual aid received I II ❑ Arrival * 1 021 1 241 I 200�I13:OS:00 I 2 ['Automatic aid recv. Their FDID Their +i3 State CONTROLLED Optional, Except forildld firesSpecial Studies 3 ❑Mutual aid given wildland p 4 ['Automatic aid given 1 I ❑Controlled 1 021 1 241 I 20071113:20:00 I Local Option 5 ['Other aid given Their LAST UNIT CLEARED, required except for wildland fires I 1 Li N ❑ l None Incident Number Last Unit I 021 I 241 1 20071113:21:00 I study SpecialD5 Study l Value0 Cleared F Actions Taken * G1 Resources * G2 Estimated Dollar Losses & Values ® Check this box and skip this section if an Apparatus or LOSSES: Required for all fires if known. Optional 186 I 'Investigate I Personnel form is used. for non fires. None —J Apparatus Personnel Property $1 1 , 1 0001,1 0001 ❑ Primary Action Taken (1) Suppression 1 I I I Contents $1 I , I 0001 ,1 0001 ❑ I II I Additional Action Taken (2) EMS I I I I PRE-INCIDENT VALUE: Optional L______I I I Other I 00011 I 00031 Property $1 I , I 0001 ,1 000.1 ❑ Additional Action Taken (3) ❑ Check box if resource counts include aid received resources. Contents $1 I s I 0001,1 000.1 ❑ Completed Modules Hl*Casualties❑None H3 Hazardous Materials Release I Mixed Use Property ❑Fire-2 Deaths Injuries N ps]None NN %Not Mixed 10 Assembly use Structure-3 Fire I 1 Natural Gas: slow leak, no evauation or Ha:east actions II I Service 1 20 Education use ❑Civil. Fire Cas.-4 2 ['Propane gas: <21 lb. tank (as in home BBS grill) 33 Medical use Li Fire Serv. Cas.-5 Civilian' I I I 3 ❑Gasoline: vehicle fuel tank or portable container 40 Residential use .-- 4®EMS-6 ❑ 51 Row of stores H2 Detector Kerosene: fuel burning equipment or portable storage 53 Enclosed mall ❑HazMat-7 Required for Confined Fires. 5 ❑Diesel fuel/fuel oil:vehicle fuel tank or portable 58 —Bus. & Residential ❑Wildland Fire-8 1 EDetector alerted occupants 6 ❑Household solvents: home/office spill, cleanup only 59 'Office use ®Apparatus-9 7 ❑Motor oil: from engine or portable container 60 —Industrial use ❑Personnel-10 2❑netector did not alert them 63 Military use 8 Paint: from paint cans totaling a 55 gallons 65 a�Farm use ❑Arson-11 U❑Unknown ❑ required or spillga 00 Other mixed use 0 Other: special HazAfat actions i ed > 55 gal., _ Please co12lete the HazMat form _ J Property Use* Structures 341❑Clinic,clinic type infirmary 539 ❑Household goods,sales,repairs 342❑Doctor/dentist office 579 ElMotor vehicle/boat sales/repair 131 ['Church, place of worship 3610 Prison or jail, not juvenile 571 ❑Gas or service station 161 ❑Restaurant or cafeteria 4190 1-or 2-family dwelling 599 ID office 162 ❑Bar/Tavern or nightclub 4290 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 ❑Manufacturing plant 241 ❑College, adult education 459❑Residential, board and care 819 ❑Livestock/poultry storage(barn) 3 1 1 ®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 1962 I 919 ❑Dump or sanitary landfill 961 ['Highway/divided highway 931 IiOpen land or field 962 pnResidential street/driveway 'Residential street, road or NFIRS-1 Revision 06/03/05 FIRE RESCUE 07009 02/24/2007 07-0018202 1 Person/Entity Involved I _J I I - I Local Option Business name (if applicable) f I Area Code Phone Number I I f�l Check This Box if I I I I II I I L�J IJsame address as Mr.,Me., Mrs. First Name MI Last Name Suffix incident location.Then skip the three I I I I I I I I I L__..J duplicate address Number lines. Prefix Street or Highway Street Type Suffix I I I I I Post Office Box Apt./Suite/Room City I II J-I J State Zip Code More people involved? Check this box and attach. Supplemental Forms (NFIRS-1S) as necessary K2 owner 0 Same as person involved? 1 j Then check this box and skip I I I I - I ( I The rest of this section. Local Option Business name (if Applicable) Area Code Phone Number I I I I I I I I L _J ❑ Check this box if Mr.,MS.. Mrs. First Name MI Last Name Suffix same address as I incident location. I I ''I�II I e-.v._J I _I L__.J Then skip the three duplicate address Number Prefix Street or Highway Street Type Suffix lI lines. I I I I I �1 Post Office Box Apt./Suite/Room City II J-L I ° State Zip Code ---- -®:.ate L Remarks Local Option Dispatched to Nevada and Independence for wire down. Found a tree branch hanging from power lines at Nevada and Madison St. This branch hanging was causing no immediate threat as lines are intact and branch is above the ground. Mid-American has been notified but is very busy with many lines down in area due to ice storm. 305 crew could do nothing to take care of this problem and Mid-American had been notified. 305 returns to service. , i L Authorization - _-ra�_[ I LILJA,P I I Lilj a, Pete I IALT I I I I 021 24 I 20071 Officer in charge ID Signature Position or rank Assignment II Month Day Year Check ® ( I I II __J I I L I I --_�.J, Box if LILJA,P Lilja, Pete LALT 02 24 2007 i same Position or rank Assignment Month Day Year as Officer Member making report In Signature in charge. _z- aa .- .. _- _ - _.. .y _. .. ®,__-_".,, -- sir_:- FIRE RESCUE 07009 02/24/2007 07-0018202 A MM DD YYYY ❑Delete NFIRS -1 107009 I IIA 1 L_o2 I 124j I 2007 I 15 I 107-0018221 1 I 0001 ❑Change Basic FDID * State* Incident Date * Station Incident Number * Exposure * ❑No Activity Module In Section B .Alternative Location Specification..ion". Use only for Wildland Eire i Census Tract 0 0 1 8 —Location* peci n y ®® ®Street address 1 00435I L ' 'LANE (%_4'-. ❑Intersection �J I 1ST I � Number/Milepost Prefix Street or Highway Street Type Suffix ❑In front of ❑Rear of L I [WATERLOO I IIA I 150703 1-Li___I Apt./Suite/Room City State Zip Code ['Adjacent to ❑Directions Cross street or directions, as applicable 1 I y fY�, e,..,, Secondary Address C Severe weather or natural, Check Date i arm '.---- Midnight is 0000 Incident Type * El & Times E2 Shift & Alarmr 800 I I I boxes f Month DayYear Hr Min Sec Local Option i Incident Type dates are the same as Alarm ALARM always required IC I I 011 I Aid Given or Received* Date. Alarm * 1 021 J 241 1 20071114:07:18 I DShift or Alarms District Platoon ARRIVAL required, unless canceled or did not arrive 1 ['Mutual aid received 1 II 1 2 ['Automatic aid recy. Their FDID Their El Arrival * I 021 1 241 1 20071114:11:0013 State CONTROLLED Optional, Except for wildland fires 3 ❑Mutual aid given p Special Studies) 4 ['Automatic aid given I I ❑Controlled I 021 I 241 I 20071114:21:00 I Local option 5 ❑Other aid given Their LAST UNIT CLEARED, required except for wildland fires I [ I_Incident Number Last Unit N ®None Special Special ❑ Cleared I 021 1 241 I 20071114:21:00 I Study IDS Study Value F Actions Taken * G1 Resources * G2 Estimated Dollar Losses & Values ® Check this box and skip this LOSSES: Re ired for all fires if known. Optional section if an Apparatus or for Personnel form is used. non fires. 186 I 'Investigate JNone Primary Action Taken (1) Apparatus Personnel property $1 I , 1 0001 d 0001 ❑ Suppression I I I! I I _.11]I Contents $1 1 , 1 0001 ;1 0001 Additional Action Taken (2) EMS 1 11 1 PRE-INCIDETdT VALUE: Optional I I I I Other 1 00011 1 00031 $I 1 , 1 0001,1 0001 PropertyD Additional Action Taken (3) ❑ Check box if resource counts LJ include aid received resources. Contents $1 1 , 1 0001,1 0001 ❑ Completed Modules H1 Casualties❑None H3 Hazardous Materials Release I Mixed Use Property II Fire-2Deaths Injuries N n None NN %Not Mixed ❑Structure-3 Fire 10 Assembly use i ! 1 J 1 ❑Natural Gas: slow lest, no°venation or HssNat actions Service 20 ®Education use ❑ vFir['Civil 4 e Cas.- 2 ['Propane gas: <21 lb. tank (as in home BBQ grill) 33 Medical use lipFire Serv. Cas.-5 Civilian! I I I 3 ❑Gasoline: vehicle fuel tank or portable container 40 Q Residential use ❑EMS-6 H2 4 ❑Kerosene: fuel burningequipment 1 ®Row of stores Detector 4u Pment Cror portable storage 53 Enclosed mall 0HazMat-7 5 ❑Diesel fuel/fuel oil fuel tank or 58 Bus. Residential Required for Confined Fires. portable Wildland Fire-8 1❑Detector alerted occupants 6 ['Household solvents: home/office spill, cleanup only 59 Office use El Apparatus-9 7 ['motor oil: from engine or portable container 60 —Industrial use LiPersonnel-10 2❑Detector did not alert them 8 63 Military use ❑Paint: from paint cans totaling< 55 gallons 65 ®Farm use ®Arson-11 U❑Unkaown 0 Other: special Haildat actions required or spill a 55ga1., ❑ 00 Other mixed use Please complete the Ha= at form M J Property Use* Structures 341❑Clinic,clinic type infirmary 539 ['Household goods,sales,repairs 34 2❑Doc:tor/dentist office 579 ❑Motor vehicle/boat sales/repair 131 ['Church, place of worship 3610 Prison orjail, notjuvenile ❑ 571 ❑Gas or service station 161 ['Restaurant or cafeteria 4190 1-or 2-family dwelling 599 ❑ Business office 162 ❑Bar/Tavern or nightclub 429❑Mu7.ti-family dwelling 615 ❑Electric generating plant 213 ❑Elementary school or kindergarten 439 Roomin ❑Rooming/boarding 4/ 9 house 629 ❑Laboratory/science lab 215 ❑High school or junior high 449❑Commercial hotel or motel 700 ❑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 669 0 Forest (timberland) Lookup and enter a Property Use code only if 951 ❑Railroad right of way you have NOT checked a Property Use box: 807 ['Outdoor storage area 960 ❑Other street Property Use 1962 1 93,9 ['Dump or sanitary landfill 961 ❑Highway/divided highway 1 931 ❑Open land or field 962 ]Residential street/driveway 'Residential street, road or NFIRS-1 Revision 06/03/05 FIRE RESCUE 07009 02/24/2007 07-0018221 K 1 Person/Entity Involved L 1 I I - I 11 Local Option Business name (if applicable) Area Code Phone Number ®Check This Box if 1 1 ( I I 11 1 U same address as Mr.,Ms., Mrs. First Name MI Last Name Suffix incident location. I I 1 1 1 _� I I I 1 1 Then skip the three duplicate address Number Prefix Street or Highway Street Type Suffix lines. I 1 I I I I Post Office Box Apt./Suite/Room City I_._II J-I 1 State zip Code ❑More people involved? Check this box and attach Supplemental Forms (NFIRS-1S) as necessary K2 Owner 0 Same as person involved? Then check this box and skip I I 1 1 - 1 i 1 I The rest of this section. Local Option Business name (if Applicable) Area Code Phone Number 1 I I IL___ II 1 I I ElCheck this box if Mr.,Ms., Mrs. First Name MI Last Name Suffix same address ti 1 1 I incident location. 1 1 I � I J Then skip the three duplicate address Number Prefix Street or Highway Street Type Suffix. lines. 1 I 1 1 I Jl Post Office Box Apt./Suite/Room City II I 1-1 J State zip Code L Remarks Local Option Dispatched to Independence and Lane. Arrived in area to find a local resident pointing out some downed branches in front of 435 Lane. She said branches had been on fire. Investigated and found some smoldering branches that had, apparently, fallen from a tree / power lines. Smoldering ends placed in ice / snow to extinguish. • Ij 4 L Authorization I LILJA,P 1 I Lilja, Pete I IALT I I I I 02 I L2,±1_1 1 20071 Officer in charge ID Signature Position or rank Assignment Month Day Year Check ® I LILJA,P I 1Lilja, Pete I IALT I I 1 I O2I I 241 I 20071 same Position or rank Assignment Month Day Year. as Officer Member making report ID Signature in charge. FIRE RESCUE 07009 02/24/2007 07-0018221 A MM DD YYYY 107009 1 aA 1 02 I 1241 I 2007J I8 1 107-0018228 0001Change NFIRS -1 0®Change Basic FDID * State* Incident Date * Station Incident Number * Exposure No Activity 1 �i.uf.:�c �,.a< <nc a„ 0012 B u Module'ZnsSection B "Alternative Location Specification". Use only for Wildland fires. Census Tract _ 00 B Location* r._ ®Street address I 012311 L 1 IEASTON -.. I IAV I L___J ❑Intersection Number/Milepost Prefix Street or Highway g y Street Type Suffix ❑In front of 0 Rear of I I [waterloo I IIA I 150702 J-1____ 1 Apt./Suite/Room City State Zip Code ®Adjacent to • �❑Directions Cross street or directions, as applicable t� I 1 i' ,i Secondary Address Incident Typey � * Midnight is 0000 El Date & Times E2 Shift & AlarmT 1444 I [power line down 1 Check boxes if Month DayYear Hr Min Sec Local Option IncidentType datesm are the I� I� 1P- same as Alarm ALARM always required Aid Given or Received* Date. Alarm * I 021 ] 241 I 20071114:35:25 1 D Shift or Alarms District Platoon ARRIVAL required, unless canceled or did not arrive 1 ❑Mutual aid received 1 IL_J ® Arrival I 011 241 1 20071114:40:00 I �3 2 ❑Automatic aid recv. Their FnID Their State CONTROLLED Optional, Except for wildland fires Special Studies) 3 ❑Mutual aid given P P P 4 ®Automatic aid given 1 J ®Controlled I 021 I 241 I 20071114:58:00 I Local Option 5 ®Other aid given Their LAST UNIT CLEARED, required except for wildland fires 1 I Le N NOne Incident Number Last Unit Special Special ® M Cleared 1 021 1 241 1 20071114:58:00 I study IDS Study Value F Actions Taken * Gl Resources * G2 Estimated Dollar Losses & Values NeiI Check this box and skip this LOSSES: Required for all fires if known. Optional section if an Apparatus or 192 1 'standby _I Personnel form is used. for non fires. None Apparatus Personnel Property $1 1 , 1 0001,1 0001 ❑ Primary Action Taken (1) Suppression I I I 1 Contents $1 1 , 1 0001,1 0001 ❑ 1 I L_______ 1 ENS I I I Additional Action Taken (2) PRE-INCIDENT VALUE: Optional L _ _J 1 J Other I 00011 1 00031 Property $1 Id 0001„1 0001 ❑Additional Action Taken (3) ❑ Check box if resource counts ❑ include aid received resources. Contents $1 I , I 0001,1 0001 Completed Modules Hi*CasualtiesDNone H3 Hazardous Materials Release I Mixed Use Property ❑Fire-2 Deaths Injuries N ENone NN .X Not Mixed ® 10 Assembly use ['Structure-3 Structure-3 3. [I Natural Gas: slow leak, no evauation or Ba=Mat actions 20 Education use Service ❑Civil Fire Cas.-4 I I 1 2 [ Propane gas: <21 lb. tank (as in home PHU grill) 33 Medical use Fire Serv. Cas.-5 Residential use Civilian[ 11 I 3 [Gasoline: vehicle fuel tank or portable container 4® ❑EMS-6 4 G Kerosene: fuel burning equipment or portable storage 51 —Row of stores H2 Detector 53 —Enclosed mall HazMat-7 Required for Confined Fires. 5 ��Dieael fuel/fuel oil:vehicle fool tank or portable 58 Bus. & Residential ®Wildland Fire-8 10netector alerted occupants 6 ❑Household solvents: home/office spill, cleanup only 59 Office use ®Apparatus-9 7 DMotor oil: from engine or portable container 60 Industrial use Personnel-10 2❑netector did not alert them ❑Paint: from paint cans totaling< 55 gallons 63 ®Military use 65 Farm use 0Arson-11 U❑Unknown 0 CI Other: Special Barbiat actions required or spill a 55gal., 00 ®Other mixed use ....... Please complete the Haewat form t' Property Use* Structures 341❑Clinic,clinic type infirmary 539 ❑Household goods,sales,repairs_.____ 342®Doctor/dentist office 579 ❑Motor vehicle/boat sales/repair 13 1 ❑Church, place of worship 3 6 1 Prison orjail, not❑ juvenile 571 ❑Gas or service station 161 ❑Restaurant or cafeteria 4 19❑ 1-or 2-family dwelling 599 ID office 162 ❑Bar/Tavern or nightclub 429 0 milt i-family dwelling 615 ❑Electric generating plant 213 0Elementary school or kindergarten 4 3 9 Rooming/boarding house 62 9❑ Laboratory/science lab 215 ❑High school or junior high 449❑Commercial hotel or motel 700 ❑Manufacturing plant 241 0 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 II1Hospital 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 LILake, river, stream 669 Forest (timberland) Lookup and enter a Property Use code only if 951 ❑Railroad right of way you have NOT checked a Property Use box: 807 ❑Outdoor storage area 960 INOther street Dump or sanitarylandfill Property Use I960 I 919 ❑ 96 1 ❑Highway/divided highway 1 931 ❑Open land or field 962 ®Residential street/driveway LStreet, Other NFIRS-1 Revision 06/03/05 FIRE RESCUE 07009 02/24/2007 07-0018228 Kl Person/Entity Involved ' I I I - I I-I Local Option Business name (if applicable) Area Code Phone Number LiCheck This Box if I I I I L__J same address as Mr.,Ms., Mrs. First Name MI Last Name Suffix incident location. I I I I I I I �� Then skip the three duplicate address Number lines. Prefix Street or Highway Street Type Suffix 1 1 I I J Post Office Box Apt./Suite/Room City III I-L_ Jl State Zip Code ®More people involved? Check this box and attach Supplemental Forms (NFIRS-1S) as necessary 2 Owner ❑ Same as person involved? Then check this box and skip _J I - I I t _J The rest of this section. Local Option Business name (if Applicable) Area Code Phone Number I I I I L._J I - 1 L_I ❑ Check this box if Mr.,Ms., Mrs. First Name MI Last Name Suffix same address as incident location. I I I I I I I I I 1 l I Then skip the three duplicate address Number Prefix Street or Highway Street Type Suffix lines. Post Office Box Apt./Suite/Room City I-I I .I-L J State Zip Code -- - LRemarks Local Option Power line down due to ice storm. Waited for Street Department to block off the street. � a . L Authorization IFROST,J I ! Frost, John I ILT I I _J I 021 124I I 2007J' Officer in charge ID Signature Position or rank Assignment Month Day Year Check I ' FROST,J I !Frost, John I LLT 16 I L 02I L 24I I 200711 Same Position or rank Assignment Month Da Year as Officer Member making report ID Signature 9 Y in charge. FIRE RESCUE 07009 02/24/2007 07-001.8228 A MM DD YYYY El Delete NFIRS -1 107009 I IA I 02 1 1 241 L 2007 I 16 1 107-0018230 1 1 0001 ®chars FDID State Incident Date g Basic * * Station Incident Number * Exposure * ❑No Activity ioe>s icaa on.. Use soy f rneu d„ o, fires. Census Tract 10014 I-10o J Location*B Module In Section B "Alternative Location Specification.. Use only for wi ldlandfires. [Street address I I Lel [ �)2nd 1 1ST 1 L___J ®Intersection Number/Mile ost Prefix P Street or Highway Street Type Suffix ['In front of ['Rear of I 1 L7aterloo I IIA 1 150702 I-L____________J Apt./Suite/Room City State Zip Code ❑Adjacent to ___1 ['Direction.['Directions I Baltimore ST Cross street or directions, as applicable Secondary Address Incident Type Midnight is 0000 El Date & Times E2 Shift & AlarmT 1 815 1 'Severe weather or natural I Check boxes if Local Option Month Day Year Hr Min Sec �, dates are the IC II 011 L_ Incident Type same as Alarm ALARM always required D Aid Given or Received* Date. Alarm * I 021 1 241 1 20071114:48:00 1 Shift or"Alarms District Platoon I ARRIVAL required, unless canceled or did not arrive 1 ❑Mutual aid received I 11 J® ® Arrival * I 021 1 241 1 20071114:57:00 I H3 2 Automatic aid recv. Their FDID Their State CONTROLLED Optional, Except for wildland fires 3 ❑Mutual aid given P Special Studies) 4 ['Automatic aid given 1 i ®Controlled 1 021 1 241 I 20071116:12:00 1 Local Option 5 ['Other aid given Their LAST UNIT CLEARED, required except for wildland fires I 1 Incident Number Last Unit S1--- N ®None ® Cleared 1 021 1 241 I 20071116:12:00 1 Studyal IDti Studyal Value F. Actions Taken* G1 Resources * G2 Estimated Dollar Losses & Values ® Check this box and skip this LOSSES: Required for all fires if known. Optional section if an Apparatus or 192 1 [Standby Personnel form is used. for non fires. None Apparatus Personnel property ,Primary Action Taken (1) $I 1 1 000 I I 000 I EI Suppression I 1 I I Contents 000 0001 0 L82 1 'Notify other agencies. J $I I ° I I°I Additional Action Taken (2) EMS 1 I I I PRE-INCIDENT VALUE: Optional I I I I Other 1 00011 1 00031 Property $I I o i cool,) 0001 Additional Action Taken (3) [ Check box if resource counts include aid received resources. Contents $1 1 ° 1 0001 °I 0001 Completed Modules Hi*Casualties❑None H3 Hazardous Materials Release I Mixed Use Property [Fire-2 Deaths Injuries N EsNone NN X Not Mixed LI Fire 10 ®Assembly use Structure-3 I I I ' 1 ❑Natural Gas: slow leak, no evauation or eseMat actions Service 20 ®Education use Civil Fi C4 ❑ re as.- 2 Propane gas: <21 lb. tank (as in home BBq grill) 33 ®Medical use DFire Serv. Cas.-5 Civilian! 1 1 1 3 ❑Gasoline: vehicle fuel tank or portable container 40 —Residential use [EMS-6 4 [Kerosene: fuel burning 51 —Row of stores Detector 9 equipment or portable storage 53 —Enclosed mall [HazMat-7 Required for Confined Fires. 5 ❑Diesel fuel/fuel oil:vehicle fuel tank or portable 58 —Bus. & Residential [Wildland Fire-8 1 Detector alerted occupants 6 ['Household solvents: home/office spill, cleanup only 59 —Office use El Apparatus-9 7 ❑Motor oil: from engine or portable container 60 —Industrial use Personnel-10 2®Detector did not: alert them 63 Military use 8 ❑Paint: from paint cans totaling< 55 gallons 65 ®`Farm use ❑Arson-11 U❑Unknown 0 Other: special MacMat actions required or spill > 55 gal.,❑ p ea 00 ®Other mixed use Please complete the Hazlfat form — j Property Use* Structures 341❑Clinic,clinic type infirmary 539 [Household goods,sales,repairs 342❑Doctor/dentist office 579 UMotor vehicle/boat sales/repair 131 DChurch, place of worship 361 Prison orjail, notjuvenile ❑ 571 [Gas or service station 161 ❑Restaurant or cafeteria 4190 1-or 2-family dwelling 599 El Business office 162 ['Bar/Tavern or nightclub 429❑Multi-family dwelling 615 ❑ Electric generating plant 213 [i]Elementary school or kindergarten 439[Rooming/boarding house 629 ❑Laboratory/science lab 215 ®High school or junior high 449❑Commercial hotel or motel 700 ❑Manufacturing plant 241 [College, adult education 459 Residential, board and care 819 311 ❑Care facility for the aged ® ❑Livestock/Poultry storage(barn) 464[Dormitory/barracks 882 ❑Non-residential parking garage 331 ['Hospital 519[Food and beverage sales 891 0 Warehouse Outside [Vacant lot ❑ 936 981 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 669 ['Forest (timberland) 951 Railroad right of wayLookup and enter a Property Use code only if [� g you have NOT checked a Property Use box: 807 [Outdoor storage area 960 [Other street Property Use 1962 1 919 ['Dump or sanitary landfill 961 [Highway/divided highway 1 931 [Open land or field 962 ff]Residential street/driveway 'Residential street, road or NFIRS-1 Revision 06/03/05 FIRE RESCUE 07009 02/24/2007 07-0018230 1 Person/.Entity Involved -® I I I - Local Option Business name (if applicable) Area Code Phone Number Check This Box if Same address as Mr.,Ms., Mrs. First Name MI Last Name Suffix incident location. I I I I I I I �J Then skip the three duplicate address Number Prefix Street or Highway Street Type Suffix lines. I I Post Office Box Apt./Suite/Room I (City uL I-L State Zip Code ❑pT More people involved? Check this box and attach Supplemental Forms (NFIRS-1S) as necessary id2 Owner 111 Same as person involved? Then check this box and skip I I I I - I ( The rest of this section. -J Local Option Business name (if Applicable) Area Code Phone Number I I I I I_I I I I I F, OCheck this box if Mr.,Ms., Mrs. First Name MI Last Name Suffix same address as incident location. I Then skip the three duplicate address Number Prefix Street or Highway Street Type Suffix lines. I J I I I -.__ Post Office Box = Apt./Suite/Room City I_II .1-L J State Zip Code L Remarks Local Option Power lines down. Stood by. s 1 3 ' ( L Authorization IMOORE,M I 'Moore, Michael I ILT 11306 I I 021 124I I 20071'• Officer in charge ID Signature Position or rank Assignment Month Day Year Check ® 1MOORE,M I 'Moore, Michael I ILT I 1306 —J I 021 L24I I 20071 same Position or rank Assignment Month Nay Year as Officer Member making report ID Signature i in charge. • FIRE RESCUE 07009 02/24/2007 07-0018230 i A MM DD YYYY El DeleteNFIRS -1 107009 1 IIA 1 02 24 L 2oo7J 14 I 1 07-0018236 I I o001 ['Change Basic FDID State Incident Date Station Incident Number , Exposure __�.� _ _ ❑No Activity [J e x „� uxo w .,ui�arc qua,. „�auure„ :nr r„„ �„� r , �,��„� eo-o:r-r-,re n ��au,,r.,' Census Tract '0015 I-1 o21 ELocation* Module`ln Section e 'Alternative`Location Specification". Ice only foruwildlana fires. -�- Street address I 18001 1 I 'Sager I AVE __J I I ❑Intersection Number/Milepost Prefix P Street or Highway Street Type Suffix ElIn front of BLK� L I I I WATERLOO IA 50703 I L--� ❑Rear of ,�s Apt./Suite/Room City State Zip Code ❑Adjacent to L f ❑Directions � Cross street or directions, as applicable Secondary Address Incident Type Midnight is 0000�� El Date & Times E2 Shift & AlarmT I444 1 'Power line down I Check boxes if Month Day Year Hr Min Sec Local Option Type dates are the Incident Typ same as Alarm ALARM always required IC I 'I o 11 14 Aid Given or Received* Date. Alarm * L�I111 I 1I o2 242007 15:14:00 I Shift or Alarms District Platoon ARRIVAL required, unless canceled or did not arrive 1 ❑Mlltllal aid received II I 0 Arrival * 1 021 1 241 1 20071115:19:00 1 �c 2 ❑Automatic aid recv. Their FDID Their ,�j3 State CONTROLLED Optional, Except for wildland fires 3 ❑Mutual aid given p Special Studies) 4 ❑Automatic aid given 1 J ❑Controlled I 021 1 2411 20071115:23:00 I Local Option 5 ❑Other aid given Their LAST UNIT CLEARED, required except for wildland fires 1 I I Incident Number Last Unit Special Special ®None ❑ Cleared I 021 I 241 1 20071115:23:00 1 study IDq Study Value F Actions Taken * G1 Resources * G2 Estimated Dollar Losses & Values ICheck this box and skip this LOSSES: Required for all fires if known. Optional section if an Apparatus or for non fires. Personnel form is used. None 145 I 'Remove hazard Apparatus Personnel property SI I , I 0001,1 0001 ❑ Primary Action Taken (1) Suppression 1 I I I Contents Si I , 1 0001,1 0001 [I I II I EMS II Additional Action Taken (2) I PRE-INCIDENT VALUE: optional I I I I Other 1 00011 I 00031 Property $1 I + I 0001,1 0001 ❑ Additional Action Taken (3) ❑ Check box if resource counts ❑ include aid received resources. Contents $1 I , I 0001,1 0001 Completed Modules H1*Casualties❑None ��3 Hazardous Materials Release I Minced Use Property ❑Fire-2 Deaths Injuries N ENone NN X Not Mixed 10 Assembly use ❑Structure_g Fire I I I I 1 ®Natural Gas: slow leak, no evaoation or HaeHat actions 2© Education use ❑Civil Fire Cas.-4 Service 2 [Propane gas: <n lb. tank tea in home eHg grills 33 Medical use ❑Fire Serv. Cas.-5 I I I ❑Gasoline: or40 .�Residential use Civilian! 3 vehicle fuel tank portable container ❑EMS-6 4 ❑Kerosene: fuelburnin equipment51 °Row of stores H2 Detector9 or portable storage 53 Enclosed mall 0HazMat-7 5 Diesel fuel/fuel oil :vehicle for Confined Fires. eseo :vehicle fuel tank or portable ❑ 58 —Bus. & Residential Wildland Fire-8 1 ®netector alerted occupants 6 ®Household solvents: home/office spill, cleanup only 59 Office use ❑Apparatus-9 7 ❑Motor oil: from engine or portable container 60 Industrial use 0Personnel-10 2CJDetector did not alert them 8 ❑paint: from paint cane totaling < 55 gallons 63 Military ties ❑Arson-11 U unknownor 65 Farm use ❑ 0 ❑Other: special HaaMat actions required spill a 55ga1., 00 ®Other mixed use Please complete the HarMat form — 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 3610 Prison or uvenile not jail, j 571 0 Gas or service station 161 ❑Restaurant or cafeteria 4 lg® 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 4490 Commercial hotel or motel 700 ❑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 0 Construction site 124 ❑Playground or park 936 Graded/care for plot of land 984 0 Industrial plant yard 655 []Crops or orchard 946 ❑Lake, river, stream 669 Forest (timbe 951 DRailroad of Lookup and enter a Property rty code only if rland) ❑ right way you have NOT checked a Property Use box: 807 ['Outdoor storage area 960 ❑Other street Property Use 1419 1 919 ❑Dump or sanitary landfill 961 ❑Highway/divided highway 1 931 ®Open land or field 962 0Residential street/driveway 11 or 2 family dwelling NFIRS-1 Revision 06/03/05 FIRE RESCUE 07009 02/24/2007 07-0018236 Kl Person/Entity Involved L I I I - I Local Option Business name (if applicable) Area Code Phone Number Check This Box if I�m - - _ -' I I I J L. _I same address as Mr.,Ms., Mrs. First Name MI Last Name Suffix incident location. I � Then skip the three I I I �-_1 duplicate address (Number I I1 Prefix Street or Highway StreetType lines. 5 y suffix I I I I I J Post office Box Apt./Suite/Room City I I—I I 1-I I State Zip Code ®More people involved? Check this box and attach Supplemental Forms (NFIRS-1S) as necessary sy-- -- —_w -�__ �2 ®taller Same as person involved? � Then check this box and skip I I I I — I I __1 The rest of this section. Local Option Business name (if Applicable) Area Code Phone Number I I I l I I l 1 L Check this box if Mr.,Ms., Mrs. First Name MI Last Name Suffix same address as incident location. I I- II I I I I L____1 Then skip the three duplicate address Number Prefix Street or Highway Street Type Suffix lines. I ( I I I Post Office Box Apt./Suite/Room City U I .J- L J State Zip Code L Remarks Local Option Respond to a report of a power line down. Investigated to find a cable tv entrance cable down. Removed from the street. 1 I L Authorization IFRESHWATER,M I ' Freshwater, Marty I ILT I 1304 I I 021 1 2411 20071 Officer in charge ID Signature Position or rank Assignment Month Day Year Box f 0 I FRESHWATER,M I 'Freshwater, Marty I LLT 1 1304 I I 02I 124I I 20071', same Position or rank Assignment Month Day Year as Officer Member making report ID Signature in charge. FIRE RESCUE 07009 02/24/2007 07-0018236 A MM DD YYYY ❑Delete NFIRS -1 07009 1 !IA 1 I 02 1 1 241 L 2007 1 18 1 107-0018241 11 0001 ❑Chan e FDIn State Incident Date * Exposure * g Basic * * * Station Incident Number ❑ �.� o Acti vity ivity �Y u,e dl.,utta�e ,.uav tie ai'd es ''Ise ,S yc„v.utu u„ a xu r 10010 1-1 00—f y �J wodule In Section E ^Alternative i.ocation Specification". use only for Wr ldlandef e 1 e Census Tract B rotation* ]Street address IiiP I 19081 LE I 'Mitchell 1 !AVE I 1____J ['Intersection Number/Milepost Prefix Street or Highway ❑In front of Street Type Suffix ❑Rear of I. 1 IWaterloo 1 IIA 1 150702 1-1 _J Apt./Suite/Room City State Zip Code ❑Adjacent to 1 �J ❑Directions Cross street or directions, as applicable Secondary Address Midnight is 0000 Incident T 4 C �e * El Date & Times E2 Shift & A:LarmT 1 444 1 'Power line down 1 Check boxes if Local Option Month DayYear Hr Min Sec p Incident Type dates are the I I 0 11 same as Alarm ALARM always required IC 1 L8_ D Aid Given or Received* Date. Alarm * 1 021 1 241 1 20071115:23:00 1 Shift or Alarms District Platoon ARRIVAL required, unless canceled or did not arrive 1 ®Mutual aid received I` JI 2 ['Automatic aid recv. (Their FDID (Their pc] Arrival * L�02J I 241 I 20071115:27:00 1 Ba 3 State CONTROLLED O 3 ❑Mutual aid given ptional, Except for wildland fires Special Studies 4 ❑Automatic aid given L. J ®Contro:Lled 1 021 1 241 1 20071115:36:001 Local Option 5 ❑Other aid given Their LAST UNIT CLEARED, required except for wildland fires I 1 I_ N ®None Incident Number Last Unit Special Special ��p�,� Ea Cleared 1 02' 1 241 20071115:36:00 1 Study IDp Study Value p Actions Taken * G1 Resources * G2 Estimated Dollar Losses & Values ® Check this box and skip this LOSSES: Required for all fires if known. Optional section if an Apparatus Or 4u Personnel form is used. for non fires. None 186 1 'Investigate I 1 Apparatus Personnel property El Primary Action Taken (1) $l I 1 00®1 I 000 Suppression 1 1 1 I Contents $1 1 0 1 000l®I 000J ❑ I 11 I EMS1 1 1 Additional Action Taken (2) PRE-INCIDENT VALUE: Optional ' I J I Other ' 00011 1 0003' Property $1 1 , 1 0001,1 000] ❑ Additional Action Taken (3) ❑ Check box if resource counts include aid received resources. Contents $1 1 , 1 000)of 00o] ❑ Completed Modules H1*Casualties❑None H3 Hazardous Materials Release I Mixed Use Property ['Fire-2 Deaths Injuries m E None NN -Not Mixed ❑Structure-3 Fire 10 Assembly use I I 1 1 3. []Natural Gas: slow leak, no evacation or aarMat actions Service 20 Education use ❑Civil Fire Cas.-4 2 ❑ Propane gas: <al lb. tank (as in Home BB()grill) 33 Medical use ❑Fire Serv. Cas.-5 Civilian' I I 1 3 []Gasoline: vehicle fuel tank or portable container 40 Residential use ❑EMS-6 51 —Row of stores H24 ❑Kerosene: fuel burning equipment or portable storage Detector53 Enclosed mall 0HaZMat-7 Required for Confined Fires. 5 ❑Diesel fuel/fuel oil:vehicle fuel tank or portable 58 Bus. & Residential ❑wildland Fire-8 10neteetor alerted occupants 6 ❑Household solvents: home/office spill, cleanup only 59 mOffice use ®Apparatus-9 7 ['Motor oil: from60 Industrial use Personnel-10 2 Detector did not alert them engine or portable container ❑ an 63 ®Military use 8 ❑Paint: from paint cans totaling< 55 gallons 65 —Farm use ®Arson-11 U❑IInknown 0 []Other: special aarMat actions required or spill > 55ga1., 00 'Other mixed use ——---- .. Please com•lete the aarliat form -- J Property Use* Structures 341❑Clinic,clinic type infirmary 539 ❑Household goods,sales,repairs 342❑Doctor/dentist office 57 9 ❑Motor vehicle/boat sales/repair 131 ['Church, place of worship 361 Prison orjail, notjuvenile❑ 571 ❑Gas or service station 161 ❑Restaurant or cafeteria 4 lg 1-or 2-familydwelling �1 5 99 ❑ Business office 162 ❑Bar/Tavern or nightclub 429['Multi-family dwelling 615 ❑ Electric generating plant 213 ❑Elementary school or kindergarten 43 9❑Rooming/boarding house 629 ❑Laboratory/science lab 215 ❑High school or junior high 449[]Commercial hotel or motel 700 ❑Manufacturing plant 241 ❑College, adult education 459 Residential, board and care 8 19 Livestock❑ ❑ /poultry storage(barn) 33.1 ❑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 0 Industrial plant yard 655 ['Crops or orchard 946 ❑Lake, river, stream 669 ['Forest (timberland) 951 Railroad right of wayLookup and enter a Property Use code only if ❑ g you have NOT checked a Property Use box: 807 ❑Outdoor storage area 960 [I Other street Property Use 1419 1 919 ['Dump or sanitary landfill 961 ❑Highway/divided highway 931 ❑open land or field 962 ❑Residential street/driveway 11 or 2 family dwelling 1 NFIRS-1 Revision 06/03/05 FIRE RESCUE 07009 02/24/2007 07-0018241 1 Person/Entity Involved I I I I Local Option Business name (if applicable) Area Ccde Phone Number ❑Check This Box if I I I I L_J I I same address as Mr.,Ms., Mrs. First Name MI Last Name affix incident location. ( I I I I Suffix Then skip the three I I I L ___ J duplicate address Number lines. Prefix Street or Highway Street Type Suffix , I I I I I 1 Post Office Box Apt./Suite/Room City L_ I I I-L _I State Zip Code LI More people involved? Check this box and attachSupplemental Forms (NFIRS-1S) as necessary K2 Owner ❑ Same as person involved? a Then check this box and skip 1 _J I I - The rest of this section. I 1 Local Option Business name (if Applicable) Area Code Phone Number I 11 ILIP __I L____I ❑ Check this box if Mr.,Ms., Mrs. First Name MI Last Name same address as Suffix incident location. I I u I I Then skip the three J L® I duplicate address Number Prefix Street or Highway 1 lines. Street Type Suffix ! I I 1 11 Post Office Box Apt./Suite/Room City LT I I I-L I State Zip Code L Remarks —y- . T _ -- Local Option Power line down in back of 1908 Mitchell Ave. due to ice storm Had dispatch notify Mid American Energy. , ( . . . . L Authorization � ` � � I FROST,J 1 ' Frost, John I ILT I I 1 I 02 1 1 2511 2007_ Position or rank Assignment Month Day Year Officer in charge ID Signature Check ® I FROST,J Box if I 'Frost, John 1 [LT I I I I 02I 1 25) I 20071 same as Officer Member making report ID Signature Position or rank Assignment Month Day Year in charge. FIRE RESCUE 07009 02/24/2007 07-0018241 A MM DD YYYY L07009 IA I 02 I L24I I 200=7 ) I3 I 107-0018253 ❑Delete �_ FDIDI I 000I NFIRS -1 * State* Incident Date * ❑Change Station Incident Number Exposure * Basic ❑No Activity BLocation* Module In Section R "Alternative Location Specification". Use only for wildland fires 1 Census Tract 0017 I-102 ®Street address ['IntersectionI 29751 I I (Airline I ICR J L� ),, Number/Milepost Prefix Street or Highway UIn front of L Street Type Suffix ❑Rear of I LWaterloo I I I I I_ ❑Adjacent to Apt./suite/Room City 50703 State Zip Code 0 Directions Cross street or directions, as applicable 1 ......:, :.:., .....,,,, Secondary Address ! ,i'Zd' ��--.. �' Incident Type * Midnightµ is 0000 , _ El Date & Times E2 Shift & AlarmT I 740 I 'Unintentional transmission of I check boxes iE Incident Type dates are the Month Day Year Hr Min Sec Local Option same as Alarm ALARM always required IC I r Aid Given orReceived* Date. Alarm * I 021 I 241 I 2007II15:42:00 01I I3 Shift or Alarms District ARRIVAL required, unless canceled or did not arrive 1 ['Mutual aid received Platoon 2 ['Automatic aid recv. (Their FDID III ] Arrival I 02' I 241 I 2007I I15:52:00 - • - - - 3 ['Mutual aid given state CONTROLLED Optional, Except for wildland fires I 3 Special Studies) 4 ['Automatic aid given controlled 02I I 241 I 2007I I16:09:®O I Local Option 5 ®Other aid given Their LAST UNIT CLEARED, re Incident Number required except for wildland fires N ®None Last; Unit Cleared Special Special ---------s---•---- ,- ..-��._� ® [ 02I I 24I I 2007I I16:33:00 ' study ioi I " - y StudyValue F. Actions Taken * Gi Resources G2 Estimated Dollar Losses & Values` I v l Check this box and skip this L.1 section if an Apparatus or LOSSES: Required for all fires if known. Optional for non fires. 186 I Ilnveatigate J Personnel form is used. Primary Action Taken (1) Apparatus Personnel Property $1 ( , I 000I,I 00„ NU I one Suppression I �j I Contents $I 1 , 1 0001,1 000] ❑ Additional Action Taken (2) I EMS I I PRE-INCIDENT VALUE: Optional I I L______ Other I 00011 ' 00031 Property $[ I r I 0001,1 00-] 0 Action Taken (3) 0 Cudbox fruce counts d resources. Contents $I I I 000 J ID Completed Modules j�1*C � I 000 ,I asualtie5❑None H3 Hazardous Materials Release I Mixed Use Property ❑Fire-2 Deaths Injuries N ElNone LJ NIN X Not Mixed Fire I JI 10 Assembly use I 1 ❑Natural Gas: slow leak, cation or sarxat actions ['Civil Fire Cas.-4 Service oea 2 Pro one 20 Education use ❑Fire Serv. Cas.-5 ❑ P gas: <zl lb. tank (as in home grill) 33 Medical use Civilian' _I I. I 3 []Gasoline: vehicle fuel tank or portable container 40 Residential use 112 Detector 4 [�Kerosene: fuel horning equipment or portable storage 51 Row of stores ❑IIazMat-7 53Enclosed mall Required for Confined Fires. 5 ❑Diesel fuel/fuel oil:vehicle fuel tank or portable �]Wildland Fire-8 58 —Bus. & Residential � 1❑Detector alerted occupants 6 []Household solvents: home/office spill, cleanup only 59 ®Office use �.:.)Apparatus-9 7 []Motor oil: from engine or portable container 60 Industrial use 0Personnel-10 2E]Detector did not alert them ®Arson-11 8 []Paint: from paint cans totaling c 55 gallons 63 Military use U❑Unknown 0 [,Other: Special Hazteat actions 65 Farm use required or spill ' 55ga1., 00 `�Other mixed use Please complete the actions ret form — 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 3610 Prison or jail, not juvenile 161 ❑Restaurant or cafeteria 57 1 ❑Gas or service station 599 4190 1-or 2-family dwelling Business office 162 ❑Bar/Tavern or nightclub ❑ 213 ❑Elementary school or kindergarten 429❑Multi-family dwelling 615 ❑Electric generating plant 439 D Rooming/boarding house 629 Laborator 215 ®High school or junior high ❑ y/science lab 449[]Commercial hotel or motel 700 t1 Manufacturing plant 241 ['College, adult education 4590 Residential, board and care 8 19 ❑Care facility for the aged ['Livestock/poultry storage(barn) 3 11 331 ['Hospital464❑Dormitory/barracks 882 ❑Non-residential parking gar age 519 0 Food and beverage sales 891 ❑Warehouse Outside 936 ❑Vacant lot 981 ❑Construction site 124 ❑Playground or park 939 Graded/care for plot of land 984 ❑ Industrial plant yard 655 ['Crops or orchard 946 ['Lake, river, stream 669 ❑Forest (timberland) 951 ['Railroad right of wayLookup and enter a Property Use code only if 807 ['Outdoor storage area you have NOT checked a Property Use box: 960 []Other street 919 ['Dump or sanitary landfill Property Use 1700 961 ❑Highway/divided highway 931 00pen land or field 962 0Residential street/driveway Manufactur,n L go processing a- -,.....- NFIRS-1 Revision 06/03/05 FIRE RESCUE 07009 02/24/2007 07-0018253 L Person/Entity Involved I L J I_____ _J I- Local Option Business name (if applicable) Area Core Phone Number ®Check This Box if I' I I I I I I 'L_i same address as Mr.,Ms., Mrs. First.Name MI Last Name I Suffix incident location. I ' I I I Then skip the three duplicate address Number Prefix Street or Hi hwa I Type I Suffix lines. Highway Street e 1 I I I I I Post Office Box Apt./Suite/Room City II I I-I I State Zip Code ®More people involved? Check this box and attach Supplemental Forms (NFIRS-1S) as necessary K2 Owner ID Same as person involved? II Then check this box and skip ( I I - I I L .____ I The rest of this section. Local Option Business name (if Applicable) Area Code Phone Number I I I 1 I.__I I 1 U ❑ Check this box if Mr.,Ms., Mrs. First Name MI Last Name Suffix same address as incident location. I ( I ' I I I ( u j Then skip the three duplicate address Number Prefix Street or Highway Street Type Suffix lines. I IPost Office Box Apt./Suite/Roo. City I I __I-I .1 State Zip Code L Remarks Local Option 303 called to Roskamp for a notifier alarm. Bad weather. Slow response. Upon arrival, we find that the power is out. Dispatch contacts key holder. Nothing else visible from the walk around. 10-8 @ 16:33 Lt J Ruehs 1 i I L Authorization 1 1 1RUEHS,J I IRuehs, Jeff I ILT I I 303 I I 021 124I I 200711 Position or rank Assignment Month Day Year Officer in charge ID Signature Check Box if 0 I RUEHS,J I IRuehs, Jeff I ILT I I 303 I I 021 124I I 20071' same Position or rank Assignment as Officer Member making report ID SignatureMonth Day Year in charge. FIRE RESCUE 07009 02/24/2007 07-0018253 A MM DD YYYY ®nelete 107009 1 1:A 1 02 I I 241 I 2007 I 11 I 107-0018258 NFIRS -1 I 0001 ® s Basic FDID * State* Incident Date * Station Incident Number * Exposure * Chan e No Activity BLocation* Module In Section B "Alternative Location Specification". Use Only for Wildiand fires. Census Tract 0017 171 1 ®Street address I 11171 I 1 !Logan �._ 1Are —JL_-1 ['Intersection Number/Milepost Prefix ['In front of p Street or Highway Street Type Suffix E]Rear of I 1 !Waterloo 1 'IA 1 150703 I-1_____®_I Apt./Suite/Room City State Zip Code ['Adjacent to ❑Directions __I Cross street on directions, as applicable 9 Secondary Address C Incident Type * El Month Da Midnight Yar is oOHooMin Sec 2 Shift Option to Alarm Date & Times r Local 444 I !Power line down 1 Check boxes if Incident Type dates are the Y same as Alarm ALARM always required IC 1 I 011 L1 D Aid Given or Received* Date. Alarm * 1 021 1 241 1 20071115:49:00 1 Shift or Alarms District Platoon 1 ['Mutual aid received J —I ARRIVAL required, unless canceled or did not arrive IL_ ® Arrival 1 021 1 241 L 20071115:56:00 i3 2 ['Automatic aid recv. Their FDID Their State CONTROLLED O 3 ['Mutual aid given ptional, Except for wildland fires Special Studies) 4 []Automatic aid given I J ®Controlled 1 021 1 2411 20071116:05:00 I Local Option 5 ['Other aid given Their LAST UNIT CLEARED, required except for wildland fires I I Incident Number Last Unit ta Special` lr 3one ® Cleared I 021 I 2411 20071116:05:00 1 study mu Study �N Value F Actions Taken * Gl Resources * G2 Estimated Dollar Losses & Values I Check this box and skip this i-=I section if an Apparatus or LOSSES: Required for all fires if known. Optional J Personnel form is used. for non fires. None 186 I !Investigate Apparatus Personnel property $I 1 , 1 0001,1 000_1 0 Primary Action Taken (1) I I I Suppression 1 I I I Contents $I 1 , I 0001,1 00(] Additional Action Taken (2) EMS 1 1 1 I PRE-INCIDENT VALUE: optional I I I I Other I 000111 00031 Property $I I > I 0001,1 000J LI Additional Action Taken (3) ® Check box if resource counts include aid received resources. Contents $1 1 , 1 0001,1 0001 0 Completed Modules Hl*Casualties❑None H3 Hazardous Materials Release I Mixed Use Property ❑Fire-2 Deaths Injuries N EiNone NN X Not Mixed O Structure-3 Fire 10 ®Assembly use ['Civil Fire Cas.-q Service I I I 1 1 ❑Natural Gas: slew leak, no evauation or HerMat actions 20 Education use 2 ['Propane gas: <21 lb. tank (as in home HBO grill) 33 a Medical use ❑Fire Serv. Cas.-5 Civilian! I I I 3 ❑Gasoline: vehicle fuel tank o 40 Residential use r portable container ❑EMs-sn 4 ❑Kerosene: fuel burning equipment or portable storage 51 'Row of stores H2 Detector 53 .--Enclosed mall ❑HazMat-7 Required for Confined Fires. 5 ❑Diesel fuel/fuel oil:vehicle fuel tank or portable 58 Bus. & Residential ❑wildland Fire-8 6 ❑Household solvents: bomeioffice spill, cleanup only 59 :Office use 1 C1Detector alerted occupants Apparatus-9 7 ❑Motor oil: 60 Industrial use from engine or portable container 63 --military Military use ®Personne1-10 2❑Detector did not alert them 8 ❑paint: from paint cane totaling< ss gallons 65 —'Farm use ❑Arson-11 �qactions required or Ua DAknOwn o ❑Other: Special HazMat qu spill > 55ga1., 00 Other mixed use '- "-' - - Please eomplete the HazMat form _. 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 3610Pr:ison or jail, not juvenile 571 ❑Gas or service station 161 ❑Restaurant or cafeteria 419 1-or 2-familydwelling g 599 ❑ Business office 162 ❑Bar/Tavern or nightclub 429 Multi-family dwelling g 615 ❑ Electric generating plant 213 ['Elementary school or kindergarten 439❑Rooming/boarding house 629 ❑Laboratory/science lab 215 ❑High school or junior high 449�1 Commercial hotel or motel L_1 700 ['Manufacturing plant 241 ['College, adult education 459['Residential, 819 ❑Livestock Residential, board and care /poultry storage(barn) 311 ['Care facility for the aged 464❑Dormitory/barracks 882 LiNon-residential parking garage 311 ❑Careifal 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 669 ['Forest (timberland) 951 ['Railroad right of wayLookup and enter a Property Use code only if L_1 g you have NOT checked a Property Use box: 807 ['Outdoor storage area 960 ❑other street Property Use [419 I 919 ['Dump or sanitary landfill 961 ❑Highway/divided highway 931 ElOpen land or field 962 ❑Residential street/driveway Il or 2 family dwelling I NFIRS-1 Revision 06/03/05 FIRE RESCUE 07009 02/24/2007 07-0018258 j11 Person/Entity Involved I _J I I I I L-J Local Option -- _ Business name (if applicable) II Area Code Phone Number ❑Check This Box if I I I I__J same address as Mr.,Ms., Mrs. First Name MI Last Name u incident location. I Suffix Then skip the three I I I I I I I duplicate address Number lines. Prefix Street or Highway Street Type Suffix I I I I I I Post Office Box Apt./Suite/Room City • I I I-I J State Zip Code More people involved? Check this box and attach Supplemental Forms (NFIRS-ls) as necessary K2 Owner 0 Same as person involved? Then check this box and skip I I I I - I The rest of this section. I-) Local Option Business name (if Applicable) Area Code Phone Number I I I L_J I I U Check this box if Mr.,Ms., Mrs. First Name MI Last Name same address as Suffix incidenth location. I I 'L_ J ( ( I ) I i Then skip the three duplicate address Number Prefix Street or Highway lines. I `I Street Type Suffix Post Office Box Apt./Suite/Roof City I I I _1-L______1 State Zip Code L Remarks Local Option Called for wire down. On arrival found service line to residence down due to a tree falling on it. Wire was still connected to the structure, on the ground in the back yard. Notified dispatch to contact Mid American. Not a hazard. ( . I 'I, Authorization INADING,L I INading, Larry I ILT I 1301 I I 021 L241 I 20071 i Officer in charge ID Signature Position or rank Assignment Month Day Year Ch eck NADING same ® I ,L I INading, Larry I (LT I I301 ( I 02IL.211 1 20071 ias n Ocfficer Member making report ID Signature Position or rank Assignment Month Day Year FIRE RESCUE 07009 02/24/2007 07-0013258 i 1 A MM DD YYYY ❑Delete - R 107009 I I 02 11241 I 2007 I 15 1 107-0018262 I I 0001 NFIRS -1 IA FDID * State Incident Date ❑Change Basic * * Station Incident Number * Exposure _ ❑No Activity .O.�ni1,,.rtuZ.c.� ,...,,'�R.u.�ea iva �nin i.,uiu..uY as ya uviu�.f u.. �Re l0.vuaai rake BLocation* Module In Section II "Alternative Location Specification'. Use only for Wildland fires. Census Tract 0000 _ ®® ®Street address ' ' 50431 ' (Lafayette I 1ST I l___I ❑Intersection Number/Milepost Prefix P Street or Highway Street Type Suffix ❑In front of ❑Rear of I I 'Elk Run Heights I IIA I 150707 I- Alt./suite/Room City State Zip Code ❑Adjacent to ❑Directions 1 Cross street or directions, as applicable C '-` Secondary Address Incident Type * C Date & Times Midnight is 0000 El E2 Shift & AlarmT 800 I 'Severe weather or natural I Check boxes if Month DaLocal Option dates are the y Year Hr Min Sec Incident Type same as Alarm ALARM always required IC I I 0 11 15 Date. D Aid Given or Received* Alarm * 1 021 I 241 1 20071115:57:00 1 Shift or Alarms District Platoon 1 ❑Mllt llal aid received ARRIVAL required, unless canceled or did not arrive ❑ I II I ❑ Arrival * I 02I I 24' I 2007I'16:08:00 13 2 Automatic aid recv. Their FDID Their 3 Mutual aid given State CONTROLLED Optional, Except for wildland fires ❑ g' Special Studies) 4 ®Automatic aid given ' ___) ❑ 241 Controlled 1021 I 2007 I'16:08:00 1 Local O Lption 5 ❑Other aid given Their LAST UNIT CLEARED, required except for wildland fires I 1 N Incident Number Last Unit Special Speci ❑None ❑ Cleared 1 021 1 241 I 20071116:08:00 1 study IDS Sttudyal Value F Actions Taken * Gl Resources * G2 Estimated Dollar Losses & Values ElCheck this box and skip this section if an Apparatus or LOSSES: Required for all fires if known. Optional 86 1 'Investigate Personnel form is used. for non fires. None Primary Action Taken (1) Apparatus Personnel property $1 1 , I 0001,1 0021 1:] Suppression I I I I , I OOOI,I OQ ' I I I I Contents $1 O� Li Action-Taken (2) J EMS I I I I PRE-INCIDENT VALUE: Optional I I I Other 1 00011 I 00031 Property $1 1 , 1 OOQI,' 0001 ❑ Additional Action Taken (3) ❑ Check box if resource counts L include aid received resources. Contents $1 1 , 1 0001,1 00_J ID Completed Modules H1*Casualties❑None H3 Hazardous Materials Release I Mixed Use Property ❑Fire-2 Deaths Injuries N EINone NIT X Not Mixed ❑Structure-3 Fire 1 J I. 1 10 Assembly use 1 ❑Natural Gas: slow leak, no evauation or HarMat actions ❑Civil Fire Cas.-4 Service 20 —4 Educationuse 2 ❑Propane gas: <21 lb. tank (as in home En grill) 33 :Medical use ❑Fire Serv. Cas.-5 civilian] I h I 3 ❑Gasoline: vehicle fuel tank or portable container 4 Q Residential use fuel burning equipment or portable storage 5 ❑EMS-6 4 ❑Kerosene: 1 Row of stores ❑YIazMat-7 H2 Detector 53 —4 Enclosed mall Required for Confined Fires. 5 0D1ese1 fuel/fuel oil:vehioie fuel tank or portable 58 BUS. & Residential. ❑Wildland Fire-8 6 ❑Household solvents: home/office spill, cleanup only 59 Office use 1❑Detector alerted occupants 0 Industrial use 0Apparatus-9 7 ❑Motor oil: 6 from engine or portable container 0Personnel-10 20Detector did not alert them paint: 63 s Military use 8 ❑ from paint cans 55 gallons totaling< gaons ❑Arson-11 65 Farm use U❑Unknown 0 ❑Other: Special HaaMat action. required or spill , 55gal., 00 Other mixed use Please Complete the HaeMat form — J Property Use* Structures 341❑Clinic,clinic type infirmary 539 ❑Household goods,sales,repairs 342 Ei Doctor/dentist office 579 ❑Motor vehicle/boat sales/repair 131❑Church, place of worship 161 ❑Restaurant or cafeteria 361❑Prison or jail, not juvenile 571 ❑Gas or service station 4190 1--or 2-family dwelling 599 ❑ Business office 162 ❑Bar/Tavern or nightclub 429u - amly dwelling ❑Multi-family 615 ❑ Electric generating plant 213 ❑Elementary school or kindergarten 439❑Rooming/boarding house 629 Laboratory/science['High school or high ❑ lab 4 junior 449 Commercial hotel or motel 241 ❑College, adult education ❑ 700 ['Manufacturing plant 459❑Residential, board and care 819 ❑Livestock/poultry storage(barn) 311 ['Care facility for the aged 464❑Dormitory/barracks Non-residential 331 ❑Hospital 882 ❑ parking garage 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 669 ❑Forest (timberland) 951 Railroad right of wayLookup and enter a Property Use code only if ❑ g you have NOT checked a Property Use box. 807 ❑Outdoor storage area 960 pother street Property Use 1963 1 919 ❑Dump or sanitary landfill 961 ❑Highway/divided highway 931 ❑open land or field 962 ❑Residential street/driveway 'street or road in commercial. I NFIRS-1 Revision 06/03/05 FIRE RESCUE 07009 02/24/2007 07-0018262 K i Person/E•ntity. Involved I J I Local Option Business name I - I I I(if applicable) Area Code Phone Number ❑Check This Box if I I I I JJ I __I J same address as Mr.,Ms., Mrs. First Name MI Last Name incident location. I Suffix Then skip the three I I I I s1 duplicate address Number I lines. Prefix Street or Highway f-J Street Type Suffix I Post Office Box I APt./Suite/Roof. City t L-____I I J-I I State Zip Code il More people involved? Check this box and attach Supplemental Forms (NFIRS-1S) as necessary K2 Owner 11 Same as person involved? Then check this box and skip I l The rest of this section. I_�� Local Option Business name (if Applicable) Area Code Shone Number Check this box if IMr.,Ms., Mrs. Ifirst Name I II I I I I MI Last Name �J same address as Suffix incident location. Then skip the three I I Li ( duplicate address Number Prefix Street or Highway ( I i I I lines. Street Type Suffix I I I I } Post Office Box Apt./SUlte/ROOM City I__I I I-I I State Zip Code L Remarks � ._ �--�. .- Local Option Dispatched for report of wire down at Lafayette in front of ERH City Hall. On arrival met by PD who says they took care of the problem by removing downed cable wires. Problem resolved. I � Fp E [ 4 F j ( f . L Authorization --- I LILJA,P I I Lilja, Pete I IALT I I I I 021 124I I 20071 i Position or rank Assignment Month Day Year Officer in charge ID Signature Check Box if® I LILJA,P I I Lilja, Pete I IALT I I I I 021 124I I 20071 same as officer Member making report ID Signature Position or rank Assignment Month Day Year in charge. FIRE RESCUE 07009 02/24/2007 07-001.8262 i i A MM DD YYYY ❑Delete NFIRS -1 107009 I I'�A 11 02 1 1 241 I 2007 I Ii I 107-0018273 11 0001 ®Change Basic FDID * State* Incident Date * Station Incident Number * Exposure ®No Activity Module In Section B "Alternative Location Specification". Use Census Tract Q Q 1 7 B Location* pecf i only for wildland fires. �6 �a T-1 O 1 r ❑Street address I 1 IE 114 t11 y�/ I 1ST ' I [, Intersection Number/Milepost (Prefix Street or Highway 9 y Street Type Suffix ❑In front of ❑Rear of I 1 Iltaterloo I IIA I 150703 1-L.. _] Apt./Suite/Roan City State zip Code ['Adjacent to E Parker ST ❑Directions Cross street or directions, as applicable Secondary Address C Incident Type * Midnight is 0000 yp El Date & Times E2 Shift & Alarmr 1 444 1 (Power line down 1 Check boxes if Month DayYear Hr Min Sec Local Option IncidentType dates are the same as Alarm ALARM always required IC I I 0 11 1 D Aid Given or Received* Date. Alarm * 1 021 1 241 1 20071116:02:00 I Shift or Alarms District Platoon ARRIVAL required, unless canceled or did not arrive 1 ❑Mutual aid received I IU ❑ ® Arrival * H2A 1 241 ( 20071116:10:QO 13 2 Automatic aid recv. Their FDID Their State CONTROLLED Optional, Except for wildland fires Special Studies) ❑ 3 Mutual aid given 4 ❑Automatic aid given 1 Controlled 1 021 1 241 I 20071116:12:00 I Local Option 5 ❑Other aid given Their LAST UNIT CLEARED, required except for wildland fires I I L Incident Number Last Unit N % None Special Special ® Cleared 1 021 1 241 20071116:12:00 I Study IDu Study Value F Actions Taken * Gl Resources * G2 Estimated Dollar Losses & Values ND Check this box and skip this section if an Apparatus or LOSSES: Required for all fires if known. Optional Personnel form is used. for non fires. None 145 1 'Remove hazard Apparatus Personnel property $l ' [ 000_1 ,1 000� ElPrimary Action Taken (1) Suppression I 1 I I Contents $1 1 , 1 00(21,1 0001 ❑ Additional Action Taken (2) EMS 1 J I 1 PRE-INCIDENT VALUE: Optional I I L____ I Other 1 00011 1 00031 Property $1 1 , 1 0001,1 0001 ❑ Additional Action Taken (3) ❑ Check box if resource counts include aid received resources. Contents $1 1 , I 0001,1 00J ❑ Completed Modules Il1 Casualties❑None H3 Hazardous Materials Release I Mixed Use Property ❑Fire-2 Deaths Injuries N in None NN X Not: Mixed 10 Assembly use ❑ Fire Structure-3 I Service I I I 1 ['Natural Gas: slow leak, no evauation or Ha:mat actions 20 =Education use ❑Civil Fi Fire Cas.-4 2 ❑Propane gas: <21 lb. tank (as in home Bap grill) 33 Medical use ❑Fire Serv. Cas.-5 civilian' J I I 3 ['Gasoline: vehicle fuel tank or portable container 40 —Residential use ❑EMS-6 4 ❑Kerosene: fuel burnin 51 m Row of stores g equipment or portable storage �2 Detector. 53 �Enclosed mall HazMat-7 / hicle fuel tank Required for Confined Fires. 5 EDiesel fuel fuel Oil:ve or portable 58 —Bus. & Residential ❑Wilciland Fire-8 )❑Detector alerted occupants 6 ❑Household solvents: home/office spill, cleanup only 59 --Office use ®Apparatus-9 7 []Motor oil: from engine or portable container 60 Industrial use ID Personnel-10 20Detector did not alert them 8 63 Military use � i Paint: from paint cans totaling< 55 gallons 65 wo Farm use ❑Arson-11 U❑Unknown 0 Other: Special secant actions required or spill55 l. ❑ a ea , 00 ®Other mixed use Please co55lete the HarMat form J' Property Use* Structures 341❑Clinic,clinic type infirmary 539 0 Household goods,sales,repairs 342❑Doctor/dentist office 579 ❑Motor vehicle/boat sales/repair 131 ['Church, place of worship 3610 Prison or jail, not juvenile 571 0 Gas or service station 161 ❑Restaurant or cafeteria 4190 1-or 2-family ❑ dwelling 599 ❑ Business office 162 0Bar/Tavern or nightclub 429❑Multi-family dwelling 615 0 Electric generating plant 213 ❑Elementary school or kindergarten 43 9❑Rooming/boardinghouse 215 ['High school or high 629 ❑Laboratory/science lab gjunior 449❑Commercial hotel or motel 700 ❑Manufacturing plant 241 ❑College, adult education 459 Residential, board and care 8 19 0 ❑Livestock/poultry storage(barn) 311 ❑Care facility for the aged 464['Dormitory/barracks 882 ❑Hon-residential parking garage 331 ❑Hospital 519❑Food and beverage sales 891 0 Warehouse Outside 936 ['Vacant lot 981. 0 Construction site 124 ['Playground or park 938 ❑Graded/care for plot of land 984 0 Industrial plant yard 655 ['Crops or orchard 946 ['Lake, river, stream 669 Forest (timberland) Lookup and enter a Property Use code only if ❑ 951 ['Railroad right of way you have NOT checked a Property Use box: 807 ❑Outdoor storage area 960 Other street ❑OthProperty Use 1962 I 919 ['Dump or sanitary landfill 961 ❑Highway/divided highway 931 ['Open land or field 962 Residential street/driveway 'Residential street, road or 1 NFIRS-1 Revision 06/03/05 ' FIRE RESCUE 07009 02/24/2007 07-0018273 K 1 Person/Entity Involved I Local Option Business name (if applicable) I_____ Area Code Phone Number I ( ( I I ( I ❑Check This Box if r.,Ms., Mrs. First Name ( ( 1 M same address asMI Last Name Suffix incident location. ( I I I I Then skip the three I I 1 �� duplicate address Number lines. Prefix Street or Highway Street Type. Suffix I Post Office Box Apt./Suite/Room City II , I-I J State Zip Code ❑More people involved? Check this box and attach Supplemental Forms (NFIRS-ls) as necessary rs-— K2 Owner 11 Same as person involved? Then check this box and skip 1 I I - I The rest of this section. 1- -_ Local Option Business name (if Applicable) Area Code Phone Number J II I I I I I l I❑ Check this box if Mr.,Ms., Mrs. First Name MI Last Name same address as Suffix incident location. I J I ( I I 4 Then skip the three duplicate address Number Prefix Street or Highway Street Type Suffix lines. Post Office Box I Apt./Suite/Roof C1't I Y u 1 -1 J State Zip Code L Remarks _ - _�.` t Local Option Called for wire down. On arrival found wire down across street. Investigation found- it to be a cable TV wire, removed from street. I j _ L Authorization _,a .._,_,_ _s. __r_.� � _- _.... _. ,., NADING,L Nadin I I g, Larry I LLT J 1301 j 1 021 1 2411 2007I' Position or rank Assignment Month Day Year Officer in charge ID Signature Check Box if El NADING,L I INading, Larry I 1LT 1 1 301 1 I 021 1241 I 20071; same as Officer Member making report ID Signature Position or rank Assignment Month Day Year in charge. FIRE RESCUE 07009 02/24/2007 07-0018273 MM DD YYYY __ 107009 1 IIA I I 02 I L241 1 2007 15 I 107-0018300 000 ❑Delete NFIRS -1 FDIDI I 1k State Incident Date * Station Incident Number I ❑Change Basic a * Exposure No Activity BLocation* Module In Section B "Alternative Location Specification". Use only for wildland fires. t Census Tract 0008 - 00 Street address C"y -f�' ❑Intersection Highway I 7101 I I (Gilbert is- Number/Milepost Prefix Street orHi 11 STre 1 Let front of Street Type Suffix []Rear of A I I �aterloo I IIA 1150703 1 I 1 Adjacent to pt./suite/Room City State zip Code ❑Directions Cross street or directions, as applicable I Secondary Address I `; ' c Incident Type * Midnight is 0000 �l Date & Times E2 Shift & AlarmT 815 J 1.25vere weather or natural I Check boxes if Incident Month Day Year Hr Min Sec Local Option Type dates are the same as Alarm ALARM always required D Aid Given or Received* Date. Alarm * 1 021 J 241 1 20071116:46:00 1 IC I I 011 15 Shift or Alarms District 1 ®Mutual aid received 1 11 I ARRIVAL required, unless canceled or did not arrive Platoon 2 DAutomatic aid recv. Their FDID Their ❑ Arrival * 1 021 1 241 1 20071116:54:00 1 3 3 Mutual aid iven State g CONTROLLED Optional, Except for wildland fires Special St-udiesl 4 ❑Automatic aid given I ❑Controlled 1 1 1241 1 5 other aid 02 20071117:30:00 1 Local Option ❑ given Their LAST UNIT CLEARED, required1 I Incident Number except for wildland fires N ®None Last Unit Cleared 1 021 1 241 20071117:30:00 1 Special Study Y pa Actions Taken * Gl Resources * G2 Estimated Dollar Losses & Values To Check this box and skip this L� section if an Apparatus or LOSSES: Required for all fires if known. Optional 186 1 'Investigate I Personnel form is used. for non fires. None Primary Action Taken (1) Apparatus Personnel Property $1 1 , I L 0001,J 00-, ❑ I 1 1 Suppression 1 I U� _J J I I Contents $1 1 . 1 0001.1 00J ❑ Additional Action Taken (2) EMS 1 I L I PRE-INCIDENT VALUE: Optional I_______J I Other 1 00011 1 00031 Additional Action Taken (3) Property $1 1 , L 0001,1 00 J 0 n1 Check box if resource counts L-J include aid received resources. Contents $1 1 , 1 0001,1 o®J 0 Completed Modules H1*Casualties None ❑ H3 Hazardous Materials Release 1 Mixed Use Property 0Fire-2 Deaths Injuries N None ®Structure-3 Fire �J MI' X Not Mixed 1 I 1 C�Natural Gas: el leak, no10 Assembly use ❑Civil Fire Cas>-4 Service emanation or Haut actions ❑ 20 —Education use 2 Propane gas: <21 lb. tank (as in home BBQ grill) 33 --Medical use ❑Fire Serv. Cas.-5 Civilian! J I I 3 0 Gasoline: vehicle fuel tank or❑EMS-6 portable container 40 ®Residential use H2 Detector 4 ❑Kerosene: fuel burning equipment or portable storage 51 Row of stores ❑HazMat-7 g Required for Confined Fires. 5 ❑Diesel fuel/fuel oil:.,e 53 Enclosed mall ❑wildland Fire-8 ninle feel tank°r portable 58 Bus. & Residential 1❑Detector alerted occupants 6 ❑Household solvents: home/office spill, cleanuponly ®Apparatus-9 ny 59 ®Office use 7 Motor oil: from engine or portable container 60 —Industrial use ®Personnel-10 2�Detector did not alert them ❑Perso Personnel-10 8 ❑Paint: from paint cans totaling< 55 gallons 63 Military use U Unknown (-� r 65 —Farm use 0 0Other: Special Harlat actions required o spill > ssgal., 00 —.Other mixed use Please complete the HazMat form _ J Property Use* Structures 341❑Clinic,clinic type infirmary 539 0 Household goods,sales,repairs 342[]Doctor/dentist office 579 ®Motor vehicle/boat sales/repair 131 []Church, place of worship 3 61[]Prison or jail, not juvenile 571 0 Gas or service station 161 ❑Restaurant or cafeteria 4 19❑ 1-or 2-family dwelling 5 99 Business office 162 O Bar/Tavern or nightclub ❑ 213 ❑Elementary school or kindergarten 429['Multi-family dwelling 615 IDElectric generating plant 439❑Rooming/boarding house 629 Laborato 215 ❑High school or junior high 0 ry/science lab 449❑Commercial hotel or motel 700 ❑Manufacturing plant 241 ❑College, adult education459❑Residential, board and care 819 Li y 311 ❑Care facility for the aged ❑ vestock/poultr storage(barn) 464❑Dormitory/barracks 882 ❑Non-residential parking 331 ❑Hospital garage 5 19❑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 669 ®Forest (timberland) []951 Railroad right of way Lookup and enter a Property Use code only if you have NOT checked a Property Use box: 807 ❑Outdoor storage area 960 ❑Other street 919 ❑Dump or sanitary landfill Property Use 1962 961 [Highway/divided highway 931 ®Open land or field 962 giResidential street/driveway 1Residential street, road or 1 NFIRS-1 Revision 06/03/05 FIRE RESCUE 07009 02/24/2007 07-0018300 K 1 Person/Entity Involved I �rnI I I _ I Local Option Business name (if applicable) _I - Area Code Phone Number ®Check This Box if �� I I I I I I same address as Mr..Me., Mrs. First Name MI Last Name Suffix incident location. dThen skip the three 1 II II _J I I L_1 uplicate address Number Prefix Street or Highway. Street Type suffix I I Post Office Box Alt./Suite/Ro I (City j II I-I I E State Zip Code More people involved? Check this box and attach Supplemental Forms (NFIRS-1S) as necessary K2 Owner 0 Same as person involved? Then check this box and skip I I I I _ I I The rest of this section. Local Option Business name (if Applicable) Area Code Phone Number I I I I I I I I I I OCheck this box if Mr.,Ms., Mrs. First Name same address as II '� MI Last Name Suffix incident location. I I u I I I I Then skip the three I duplicate address Number Prefix Street or Highway Street Type Suffix lines. Post Office Box I Alt./Suite/Ro� I City L_1 I I- l 1 State Zip Code �.. —. _ L Remarks Local Option '.. Dispatched for wire down. • Arrived to find a broken powerpole with lines in roadway. There is still power to the house. Residents state they have 3 people on 02 concentrators and need electricity. Dispatched contacted and told of problem. Street department contacted and they bring barricades to block off street until repairs can be made. i f L Authorization I LILJA,P I I Lilj a, Pete I IALT I I 11 02 1124I 1 20071 Position or rank Assignment Month Day Year Officer in charge ID Signature Box if ® (LILJA,P I 1Lilja, Pete I IALT I I I I 02I 1 241 I 2007 same ia.n Officer Member making report ID Signature Position or rank Assignment Month Day Year I 9 I FIRE RESCUE 07009 02/24/2007 07-0018300 i A MM DD YYYY [:]Delete NFIRS -1 107009 I ITA I , I 02 I [ 241 I 2007 I 18 I 107-0018308 I I 0001 ®change Basic FDID * State* Incident Date * Station Incident Number * Exposure Elko Activity $ Location* 00 Moe In Section S .Alternative Location Specification". Use only for wildland fires. Census Tract 0 0®9 - dul Street address ° I ,35651 I I ►Hammond I PAVE I L___J ['Intersection Number/Milepost Prefix Street or Highway ['In front of Street Type Suffix ❑Rear of I I !Waterloo I IIA 1150702 1-L._____ Apt./Suite/Room City State Zip Code ['Adjacent to ❑Directions Cross street or directions, as applicable Secondary Address Midnight is 0000 C Incident Type * El Date & Times g E2 Shift & Alarm L 444 I 'Power line down I Check boxes if MonthLocal Option I DayYear Hr Min Sec Incident Type datesm are the IC I I 0 lI I8 same as Alarm ALARM always required L_f Date. D Aid Given or Received* Alarm * I 021 J 241 I 2007I I16:52:00 I Shift or Alarms District Platoon ARRIVAL required, unless canceled or did not arrive 1 ['Mutual aid received I IhJ ® 02❑ Arrival * I 241 I 2007I I16:56:00 I E3 2 Automatic aid recv. Their Fnln Their 3 ['Mutual aid given State CONTROLLED Optional, Except for wildland fires❑ Special Studies) 4 ['Automatic aid given I —I ®Controlled I 021 I 241 I 2007I117:04:00 I Local Option 5 ❑Other aid given Their LAST UNIT CLEARED, required except for wildland fires I - Incident Number Last Unit S1.e�..1 N oc None III Cleared I 021 I 241 I 20071I17:04:00 I Studyal lD# Studyal Value F Actions Taken* Gl Resources * G2 Estimated Dollar Losses & Values Check this box and skip this LOSSES: Required for all fires if known. Optional section if an Apparatus or I Personnel form is used. for non fires. None 186 I 'Investigate P Apparatus Personnel property $I I , I 0001,1 0001 ❑ Primary Action Taken (1) Suppression I I I I Contents $I 1 , 1 0001,1 000j ❑ I I I I EMS Additional PRE-INCIDENT VALUE: Optional Action Taken (2) I I I I Other I 00011 I 00031 Property $I I ' L 0001,1 000-I ❑ Additional Action Taken (3) ❑ Check box if resource counts /�� include aid received resources. Contents $I I , I 0001,I 00J ❑ Completed Modules H1*Casualties❑None H3 Hazardous Materials Release T Mixed Use Property ❑Fire-2 Deaths Injuries N Ei None NN XNot Mixed ❑Strucure-3 10 Assembly use t Fire L________] I I 1 ❑Natural Gas: slow leak, no era ation or Ha:east actions 20 —Education use ❑Civil Fire Cas.-4 Service t—�J 2 ['Propane gas: <21 lb. tank (as in home HBO grill) 33 :Medical use ['Fire Serv. Cas.-5 Civilianl I L I 3 ❑Gasoline: vehicle fuel tank or portable container 40 .- Residential use ❑EMS-6 4 ❑Kerosene: fuel burning 51 —Row of stores H2 Detector g equipment or portable storage 53 Enclosed mall ❑HazMat-7 5 ❑Diesel fuel/fuel oil fuel tank o Required for Confined Fires. r portable 58 —Bus. & Residential ❑Wildland Fire-8 1®Detector alerted occupants 6 ['Household solvents: home/office spill, cleanup only 59 Office use ®Apparatus-9 '7 ❑Motor oil: from engine or 60 s Industrial use portable container ®Personnel-10 20Detector did not alert them 8 ❑paint: from paint cans totaling< 55 gallons 63 Military use 111Arson-11 U❑Unknown 0 Other: Special HseMat actions required or spill > 55ga1., 65 —Farm use ❑ Please complete the HarMat form ®® ®Othee r mixed use J Property Use* Structures 341❑Clinic,clinic type infirmary 539 0 Household goods,sales,repairs 342 El office ❑D 579 ❑Motor vehicle/boat sales/repair 131 ['Church, place of worship 3610 Prison or jail, not juvenile 161 ❑Restaurant or cafeteria ❑ 1 en e 57 1 ❑Gas or service station 4 19 E1 1-or 2-family dwelling 599 ❑ Business office 162 ['Bar/Tavern or nightclub 42 9 u -famil Mlti ® y dwelling 615 0 Electric generating plant 213 ❑Elementary school or kindergarten 439❑Rooming/boarding house 629 ❑Laboratory/science .1.ab 215 ['High school or junior high 449 Commercial hotel or motel 241 ®College, adult education ® 7 00 ❑Manufacturing plant 4 59❑Residential, board and care 819 ❑Livestock/poultry storage(barn) 311 ['Care facility for the aged 464❑Dormitory/barracks 882 ❑Noh-residential parking garage 331 ['Hospital 51.9['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 669 ['Forest (timberland) 951 Railroad right of wayLookup and enter a Property Use code only if ❑ g you have NOT checked a Property Use box: 807 ❑Outdoor storage area 960 ®Other street Property Use 1419 I 919 ['Dump or sanitary landfill 961 ❑Highway/divided highway 931 ['Open land or field 962 ['Residential street/driveway 11 or 2 family dwelling I NFIRS-1 Revision 06/03/05 FIRE RESCUE 07009 02/24/2007 07-0018308 I{1 Person/Entity Involved Local Option I I I _ I I_I Business name (if applicable) Area Code Phone Number I I I I I I Check This Box if same address as Mr.,Ms., Mrs, First Name MI incident location. Last Name Then skip the three I ( I u I I L_ Suffix duplicate address __ I I lines. Number Prefix Street or Highway Street Type suffix. Post Office Box Apt./Suite/Room City State Zip Code ®More people involved? Check this box and attach Supplemental Forms (NFIRS-1S) as necessary K2 Owner 0 Same as person involved? Then check this box and skip I .a ,... The rest of this section. Local Option Business name (if Applicable). pplicable) I I I I � ` e I` I Area Code Phone Number IDCheck this box if IMr.,Ms., Mlrs. First Name I tJ I I L I same address as MI Last Name incident location. I I 1 I Suffix Then skip the three U duplicate address Number I L_� Prefix Street or Highway Street lines. Type Suffix Post Office Box Apt./Suite/Room �City State I I-I I Zip Code L Remarks ��_"— Local Option _.-..._.n-.- -F�f �_m���"- Report of power line down. T.fee was on the wires hut not down. Investigated and advised. Ir - } I I i I L Authorization v ___.�IFROST,J I ( Frost, John. I Officer in charge ID Si ature — I LT I I I ( I I.2$I I 20071 gn Position or rank Assignment Month Day Year Check Box if® FROST,J I 'Frost, John _ I (LT . same I I I I 02I 125I I 2007�r as Officer Member making report ID Signature Position or rank in charge. Assignment Month Day Year s FIRE RESCUE 07009 02/24/2007 07-0018308 i IA MM DD YYYY ❑Delete NFIRS -1 107009 I LaiI 02 I 124I I 2007 I 16 I 1 07-0018311 I I 000 l ❑Chan FDID * State* Incident Date * Station Incident Number * Exposure * g Basic ❑No Activity 11 II uVA 0 014 B Location* L..I Nodule`insSection s "Alternative Location Specification.. Use only for wildland fires. Census Tract e—'/_ ❑Street address i I l (3 rd j Intersection Number/Milepost IVa Prefix or Highway I (ST I L_JII ❑In front of Street Type Suffix ❑Rear of I I lyaterloo I IIA 11507 01 1-1 Apt./Suite/Room City State Zip Code ®Adjacent to I ❑Directions Moir ST Cross street or directions, as applicable Secondary Address 2 ' lc- C Incident Type * Midnight is 0000 El Date & Times E2 Shift & Alarmr I815 1 'Severe weather or natural I Check boxes if Month DayYear Er Min Sec Local Option dates are the IC 1 I 01I II Incident Type same as Alarm ALARM always required D Aid Given or Received* Date. Alarm * I 021 J 241 I 2007II17:14:00 I Shift or .Alarms District Platoon ARRIVAL required, unless canceled or did not arrive 1 ❑Mutual aid received I IL.__I 2 ❑Automatic aid recv. Their FDID Their ® Arrival * 102I ( 241 I 2007I'17:21:00 ' E3 State CONTROLLED O 3 Mutual aid given ptional, Except for wildland fires Special Stud1e SI 4 []Automatic aid given I J ®Controlled I 021 I 24j I 20071117:40:00 ] Local Option 5 []Other aid given Their LAST UNIT CLEARED, required except for wildland fires Incident Number Last Unit l �_ l N ®None ® Cleared I 02' I 241 I 20071117:40:00 I study a ID# Study l Value F Actions Taken * Gl Resources * G2 Estimated Dollar Losses & Values ® Check this box and skip this LOSSES: Required for all fires if known. O tional section if an Apparatus or p Personnel form is used. for non fires. 155 I 'Establish safe area 000I I 0001 N❑ Apparatus Personnel Property $I 1 , 1 , Primary Action Taken (1) Suppression I I I I Contents 0001,1000 [$2 I !Notify other agencies. I $I I , I Additional Action Taken (2) EMS I I I I PRE-INCIDENT VALUE: optional L_______I I _J Other I 00011 I 00031 Property $I I , I 0001,1 000J ❑ Additional Action Taken (3) ❑ Check box if resource counts include aid received resources. Contents $I I , I 0001,1 000I ❑ Completed Modules Hi*Casualties❑None 1/3 Hazardous Materials Release I Mixed Use Property ❑Fire-2 Deaths Injuries N ElNone NN Not Mixed ❑Structure-3 Fire 10 Assembly use I I I I 1 ��Natural Gas: slow leak, no evauation or earWWat actions 20 Education use Civil Fire Cas.-4 Service 2 ti ❑Propane gas: c21 lb. tank (as in home eel grill) 33 Medical use ❑Fire Serv. Cas.-5 Civilianl II I 3 LIGasoline: vehicle fuel tank or portable container 40 —Residential use ❑EMS-6 51 —Row of stores Detector 4 Cl Kerosene: fuel burning equipment or portable storage d mall ❑HazMat-7 H2 5 ❑Diesel fuel/fuel oil: chicle fuel tank or portable 58 Bus. & Residential Required for Confined Fires. ❑wildland Fire-8 lI]Detector alerted occupants 6 ❑Household solvents: home/office spill, cleanup only 59 Office use 0 Apparatus-9 7 Motor oil: from engine or 60 ❑ portable container Industrial use g Personnel-10 2❑Detector did not alert them 63 Military use 8 ❑Paint: from paint sans totaling c 55 gallons 0Arson-11 jj®Dnknown 65 Farm use ® ❑Other: Special Nernst actions required or spill > 55ga1., 00 m'Other mixed use Please complete the Ha.mat form L' 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 57 1 ❑Gas or service station 161 ❑Restaurant or cafeteria 4 19❑ 1-or 2-family dwelling 599 ❑ Business office 162 ®Bar/Tavern or nightclub 429❑Multi-family dwelling 615 ❑ Electric generating plant 23.3 ❑Elementary school or kindergarten 439❑Rooming/boarding house 629 ❑Laboratory/science lab 215 ❑High school or junior high 4490 Commercial hotel or motel 700 ❑Manufacturing plant 241 ['College, adult education 459 Residential, board and care 8 19 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 669 ❑Forest (timberland) 951 ht Of wa Lookup and enter a Property Use code only if Railroad rl ❑ g y you have NOT checked a Property Use box: 807 ❑Outdoor storage area 960 ❑Other street Property Use 1962 I 919 ❑Dump or sanitary landfill 961 Highway/divided highway I 931 Lippe" land or field 962 ®Residential street/driveway (Residential street, road or NFIRS-1 Revision 06/03/05 FIRE RESCUE 07009 02/24/2007 07-0018311 K l Person/Entity Involved _ a Local Option I Business name I I J - I I �� J (if applicable) Area Code Phone Number I ( I I i Ill Check This Box if same address as Mr.,Ms., Mrs. First Name MI incident location. Last Name Then skip the three Suffix duplicate address Number I I I LJ lines. Prefix Street or Highway I Street Type Suffix I I I I Post Office Box Apt./Suite/Room City L_._J I I-I i State Zip Code ❑More people involved? Check this box and attach Supplemental Forms (NFIRS-1S) as necessary K2 — ; .m r� . Owner � Same as person involved? Then check this box and skip I The rest of this section. I I I - I I-�� Local Option Business name (if Applicable) Area Code Phone Number ❑ Check this box if IMr.,Ms., MI s. I irst Name I _--+ I I same address as MI Last Name L incident location. I I Suffix Then skip the three I_J I I I I U duplicate address Number Prefix Street or Highway lines. Street Type Suffix Post Office Box I Alt./Suite/Roof I ITJI I-I I State Zip Code f L Remarks --'-- - _� Local Option Power line down in street. Used fallen tree limbs to block the road. Advised Mid.America E • i ,___� L Authorization 'MOORE,M I 'Moore, Michael I 1LT 130 I 021 Officer in charge ID Signature I Position or rank Assignment Monthth Dayy Year 2007 i Check E Box if® J MOORE,M I (Moore, Michael I 1 LT I same 1306 ' I 02' 124' I 200711 as Officer Member making report ID Signature - Position or rank in charge. Assignment Month Day Year FIRE RESCUE 07009 02/24/2007 07-0018311 A MM DD yyyy 107009 I IA 1 02 I L241 1 2007 8 ❑Delete NFIRS -1 FDID 1 J 107-0018310 1 1 0001 State* Incident Date * Station Incident Number ®Change Basic _ Exposure le ❑No Activity B LAMuxe'Z'suuiTBT �lbt ee ntant�iv�eu cautun n peu fu ion uUus,e oa ludua n„eferesa„u rY: Tract Census TId Ct10002 Jf_ O® I r''�. i ❑Street address I P` Intersection 1 1 LW 1 11ltli I Number/Milepost Prefix Street or Highway 1 I sT 1 L___J Street Type Suffix ['In front of ['Rear of L I (waterloo 1 'IA 1 150702 IL_ 1 Apt./Suite/Room City ®Adjacent to State Zip Code ❑Directions 1 Williston AVE Cross street or directions, as applicable I 1 Secondary Address �1 (�' Incident Type �k Midnight is 0000 Date & Times E2 Shift & Alarm I 444 1 (Power line down Check boxes if Incident Type dates are the mouth Day Year Hr Min Sac Local Option same as Alarm ALARM always required IC I I 01.1 19 DAid Given or Received Date. Alarm 1 021 1 241 1 20071117:04:00 1 Shift or Alarms District I ARRIVAL required, unless canceled or did not arrive 1 ['Mutual aid receivedPlatoon (Their F➢ID (Their State El Arrival 1 021 24 I 2007I I17:1 1:®O I3 2 ['Automatic aid racy. 3 ❑Mutual aid given CONTROLLED Optional, Except for wildland fires Special Studie@I 4 ❑Automatic aid given I ®Controlled I 021 1 241 1 2 1 0071117:11:001 Local Option 5 Other aid given Their LAST UNIT CLEARED, required except for wildland fires I I I N X None Incident Number ® Last Unit S1 021 1 241 I 20071117:11:00 1 stud io#ecial Special Cleared v Study value F" Actions Taken * Gl Resources ale G2 Estimated Dollar Losses & Values ferl Check this box and skip this L�� section if an Apparatus or LOSSES: Required for all fires if known. Optional I86 1 'Investigate Personnel form is used. for non fires. None Primary Action Taken (1) Apparatus Personnel Property $I 1 „ 1 0001,1 QOQI El 1 1 I Suppression I I 1 Contents $1 I , I cool,) oQQI Additional Action Taken (2) EMS 1 I I PRE-INCIDENT VALUE: Optional I 1 I I Other 1 00011 1 00031 Additional Action Taken (3) Property $1 I P 1 0001,1 000j D ❑ Check box if resource counts include aid received resources. Contents $I 1 , 1 0001,1 000] ElCompleted Modules t� rgl*Casualties❑None H3 Hazardous Materials Release I Mixed Use Property ['Fire-2 Deaths Injuries N EiNone NN 1( Not Mixed ❑Structure-3 Fire 1 I I 1 ❑Natural Gas: 10 Assembly use Service slow leak, no evauation or HdZMat actions Civil Fire Cas.-4 20 Education use 2 ['Propane gas: <21 1b. tank (as in home HBO El Fire Serv. Cas.-5 I I grill) 33 Medical use Civilian) I 3 [,Gasoline: vehicle fuel tank or portable container 40 —Residential use ❑EMS-6 ❑HazMat-7 H2 Detector 4 ❑Kerosene: fuel burning equipment or portable storage ewe 51 Row of stores Required for Confined Fires. 5 ['Diesel fuel/fuel oil:vehicle fuel tank or portable 53 Enclosed mall [IWildland Fire-8 58 --Sus. & Residential 10Detector alerted occupants 6 ['Household solvents: home/office spill, cleanup only 59 ®Office use ®Apparatus-9 7 ['Motor oil: from engine or portable container 60 Industrial use 0 Personnel-10 20Detector did not alert them 63 Military use 0Arson-11 8 ['Paint: from paint cans totaling< 55 gallons U unknown 65 —Farm use ❑ 0 ❑Other: Special HarMat actions required or spill > 55ga1., 00 Other mixed use Please tom la p t¢ the HazMat form _ or Property Use* Structures 341❑Clinic,clinic type infirmary 539 ❑Household goods,sales,repairs 342❑Doctor/dentist office 579 ❑Motor vehicle/boat sales/repair 131 ❑Church, place of worship 3610jail, not 161 ❑Restaurant or cafeteria Prison or juvenile 571 ❑Gas or service station 419❑ 1-or 2-family dwelling 599 0 Business office 162 ❑$ar/Tavern or nightclub 429❑Multi-family dwelling 213 DElementary school or kindergarten 615 El Electric generating plant 439❑Rooming/boarding house 629 Laboratory/science[�FTigh school or junior high 449❑ ❑ lab Commercial hotel or motel 700 ❑Manufacturing plant 241 0 College, adult education 459❑Residential, board and care 311 ❑Care facility for the aged 819 ❑Livestock/poultry storage(barn) 464❑Dormitory/barracks ❑Non-residential parking garage 331 ❑Hospital 882 519 E Food and beverage sales 891 0 Warehouse Outside 936 ❑Vacant lot 981 0 Construction site 124 ['Playground or park 938 [Graded/care for plot of land 984 0 Industrial plant yard 655 []Grope or orchard 946 ❑Lake, river, stream 669 ['Forest (timberland) 951 ['Railroad right of wa Lookup and enter a Property Use code only if 807 0 Outdoor storage area y you have NOT checked a Property Use box: 960 ®other street Property Use 1960 1 919 ❑Dump or sanitary landfill 961 ®Highway/divided highway 931 ®Open land or field ['Residential (Street Other 1 962 street/driveway NFIRS-1 Revision 06/03/05 FIRE RESCUE a 07009 02/24/2007 07-0018310 1 Person/Entity Involved I �� Local Option Business name (if applicable) I L�� Area Code Phone Number I I I I L I I. same address as Mr.,Ms., Mrs. First Name MI Last Name ---"'1 ❑Check This Box ifI incident location. Then skip the three I I I I L__ Suffix I I U duplicate address Number lines. Prefix Street or Highway Street Type Suffix I I I I I Post Office Box Apt./Suite/Room City L_ I I I-I I State Zip Code More people involved? Check this box and attach Supplemental Forms (NFIRS-1S) as necessary K2 Owner n Same as person involved? 4 Then check this box and skip I I I I The rest of this section. - I l I I(-_-� Local Option Business name (if Applicable) Area Code Phone Number iii l I I I L_J I _1 L_J Check this box if Mr.,Ms., Mrs. First Name MI Last Name same address as Suffix incident location. I I U f Then skip the three I I I L duplicate address Number Prefix Street or Highway lines. Street Type Suffix I Office BOx I A It./Suite/Room I City i L_J I J-I I State Zip Code _... ........_. ., ........_,gym �m f L Remarks s {Local Option Report of line down--was in a yard and not completely down--not an immediate hazard. P I . i . E ... .�_,.. u. L Authorization 1FROST,J I ' Frost, John I ILT 02I 125I I 20071' Position or rank Assignment Month Day Year Officer in charge ID Signature Check Box if® I FROST,J I !Frost, John LT same I I I I 02' 125I I 2007 as Officer Member making report ID Signature in charge. Position or rank Assignment Month DayI' Year FIRE RESCUE 07009 02/24/2007 07-0018310 . MM DD YYYY A 07009 J I IA I I 02 1124I I 2007 J 13 ❑Delete NFIRS -1 FDID State i I07-0018345 I I 000' * Incident Date ❑Change * ------ _ Station Incident Number Basic -. * Exposure * r ❑No Activity B Location* +Module`Ins Section➢ "Alternative Location Specification". Use only for Wildland fires. yr } Census Tract 0 017 - 02 Street address :-- J ®Intersection I 28501 [J 14th z . .' Number/Milepost Prefix Street or Highway I I I I ❑in front of Street I 'waterloo Type Suffix [Rear of I 150703 ❑Adjacent to Apt./Suite/Room city IA I—I_ State Zip Code ❑Directions Cross street or directions, as applicable I 1 .,�yj Secondary Address le sr,,' � C Incident Type * Midnight is 0000 I E1 Date & Times 2 Shift & Alarmr 444 I `power line down I Check boxes if Month Incident Type dates are the Day Year Hr Min Sec Local Option , same as Alarm ALARM always required D Aid Given or Received* Date. AlarmI 02I 24I I IC I I O1I I3 2007I I17:36:00 I Shift or Alarms District 1 ❑Mutual aid received I I ARRIVAL required, unless canceled or did not arrive Platoon 2 [ Automatic aid recv. IL� ® Arrival * I 02I I 241 I 2007I I17:37:00 I Their FDID TheirE 3 3 ❑Mutual aid given State CONTROLLED Optional, Except for wildland fires 4 ❑Automatic aid given Special St,udiesl Controlled 5 other aid --J ® [ 021 1 241 I 2007II17:38:00 I Local. Optionp ❑ given Their LAST UNIT CLEARED, required except for wildland fires I • I Ie _ N ®None Incident Number Last Unit POCleared I 02I I 24I I 20071117:42:00 I sttudyal IDS SttudydValue Actions Taken * !7�'1 Resources * G2 Estimated Dollar Losses & Values rl Check this box and skip this L� section if an Apparatus or LASSES: Required for all fires if known. Optional Ig6 I 'Investigate I Personnel form is used. for non fires. Primary Action Takenes (1) Apparatus Personnel None Property $I I . I OOOI,I 0001 0 II I Suppression I I I J I Contents $1 I , I 000l,I ®®oI Additional Action Taken (2) EMS I PRE-INCIDENT VALUE: Optional I I I I Other I 0001I I 00031 Additional Action Taken (3) Property $1 I • I 0001,1 00 J [2 0 Chne db oax f rrouvrce counts id resources, Contents $I IsI OOO 0 �1*C Completed Modules I,asualties❑None ID Hazardous Materials Release Mixed Use Property ❑Fire-2 Deaths Injuries N None ❑Structure-3 Fire �� EN X Not Mixed J I I 1 ❑Natural Gas: slow leak, no evauacion or Hart actions 10 Assembly use ❑Civil Fire Cas.-4 Service 1 20 Education use O Fire Serv. Cas.-5 2 ��Propane gas: <u lb. Bank sae in none sea grin 33 ®Medical use Civilian' I I I 3 ❑Gasoline: vehicle fuel tank DENS-6 H2or portable container 40 Residential use ❑HazMat-7 Detector 4 ❑Kerosene: fuel burning equipment or portable storage 51 Row of stores Required for Confined Fires. 5 ❑Diesel fuel/fuel oil:�e53 Enclosed mall.[�Wild'land Fire-8 hicle fuel tank or portable 58 —Bus, & Residential 1[IDetector alerted occupants 6 []Household solvents: Home/office ®Apparatus-9 spill, cleanup only 59 Office use Personnel-10 2[JDetecto 7 ❑Motor oil: from engine or portable container 60 "—Industrial use r did not alert them 8 ❑Paint: from paint cans totaling< ss gallons 63 Military use U❑Unknown 0 []Other: Specialr 65 Farm use ❑Arson-11 HazMat actions required ospill a 55ga1., Please complete the HazMat form ®® �'Other mixed use ,« J Property Use* Structures 341❑Clinic,clinic type infirmary 539 Household❑ goods,sales,repaira 131 ❑Church, place of worship 3420Doctor/dentist office 579 0 Motor vehicle/boat sales/repair 361❑Prison or jail, not juvenile 161 Ill Restaurant or cafeteria $71 ❑Gas or service station 162 OBar/Tavern or nightclub 4190 1-or 2-family dwelling 599 0 Business office 213 ®Elementary school or kindergarten 429['Multi-family dwelling 615 0 Electric generating plant 215 ❑High school or junior high 629 ❑Laboratory/science lab 449❑Commercial hotel or motel 241 ❑College, adult education 700 ['Manufacturing plant 459❑Residential, board and care 819 DLivestock/poultry storage(barn) 311 ❑Care facility for the aged 331 ❑Hospital 464❑Dormitory/barracks 882 ❑Non-residential parkin 519[Food and beverage sales g garage Outside 891 El 936 ❑Vacant lot 981 0 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 669 ❑Forest (timberland) 951 ®Railroad right of way Lookhave d enter a d Praperty Userty codeUse bonly if x807 0 Outdoor storage area 960 ❑Other street I 919 ❑Dump or sanitary landfill Property Use 1962 961 ❑Highway/divided highway 931 ❑Open land or field 962 gResidential street/driveway 'Residential street, road or I NFIRS-1 Revision 06/03/05 FIRE RESCUE 07009 02/24/2007 07-0018345 IC1 Person/Entity Involved Local Option I I I - I I_ Business name (if applicable) I Area Code Phone Number I ,' s El Check This Box if I I I I II I I I I Same address as Mr.,Me., Mrs. First Name MI Last Name incident location. I Suffix Then skip the three I I I duplicate address Number I I I I—I lines. Prefix Street or Highway Street Type Suffix. Post Office Box I Alt./Suite/Room city u I I-I J State zip Code More people involved? Check this box and attach Supplemental Forms (NFIRS-1S) as necessary K2 Owner 4 Same as person involved? Then check this box and skip I i The rest of this section. I I I _ I I________I Local Option Business name (if Applicable) Area Code Phone Number ❑ Check this box if IMr.,Ms., MI s. First Name I I I �I same address as MI Last Name incident location. I I Suffix Then skip the three I � ( I ( I U duplicate address Number Prefix Street or Highway lines. Street Type Suffix Post Office Box I Alt./Suite/Room city II I I State zip Code L Remarks Local Option 303 called to 2850 E 4th for power line down across the roadway. Upon arrival, we find a cable wire that had pulled loose from the house. The wire was cut and tied to the utility pole. 10-8 @ 17:42 Lt J Ruehs t f 1 ' . yI . L Authorization ®v- �_, IRUEHS,J I 1Ruehs, Jeff IILT 303 I I 021 I I 20071' Officer in charge ID Signature Position or rank Assignment Month Dayy Year Check Box if® I RUEHS,J I (Ruehs, Jeff LT L 303 same I I I I I 021 I 241 I 20071' Position as Officer Member making report ID Signature or rank Assignment in charge. 4 Month Day Year FIRE RESCUE 07009 02/24/2007 07-0018345 A IV VI DD YYYY 107009 I IA I 02 I L24I I 2007 I 13 I I07-0018352 I I 0001 El Delete NFIRS -1 FDID * State* Incident Date ,k Station Incident Number * Exposure * ['Change Basic -_,--_ • ❑No Activity B"Alt end ation n eci icat on". Use is y for Wufires. u r e I-[c Location* �Module`In Section B "Alternative Location Specification". only for Wildland�fires. ?nsus Tract 10016 B MStreet address y,%j I 30221 IE I 'Airpor.t I 'By I I I ❑Intersection Number/Milepost Prefix Street or Highway Street Type Suffix ❑In front of ❑Rear of I I 'Waterloo I IIA 1150703 1-L__ Apt./Suite/Room City State Zip Code ['Adjacent to ❑Directions Cross street or directions, as applicable e Secondary Address t� c) IInintentional transmission of El . .... ...... ... ..-..rm.. Incident Type * Midnight is 0000 Date & Times E2 Shift & Alarm$ 740 I I I if MonthLocal Option DayYear Hr Min Sec Incident Type dates are the same as Alarm ALARM always required I Shift or c I (A fpli [3 D Aid Given or Received* Date. Alarm * I 021 1 241 I 20071117:46:00 I � Alarms District Platoon 1 ['Mutual aid received I Ill ARRIVAL required, unless canceled or did not arrive 2 ['Automatic aid recv. Their FDID T ® Arrival * I 021 I 2411 2007I I17:46:00 I E3 S CONTROLLED 3 ['Mutual aid given Optional, Except for wildland fires Special Studlesl 4 ❑Automatic aid given I ®Controlled ' 021 I 241 I 2007II18:01:00 I Local Option 5 ❑Other aid given Their LAST UNIT CLEARED, required except for wildland fires L_ Incident Numb Last Unit Special Special L . N ®None ® 1 02I I 241 I 2007I I18:14:00 I Study IDq Study Value Cleared F. Actions Taken * G1 Resources * G2 Estimated Dollar Losses & Values Iv1 Check this box and skip this l`_'1 section if an Apparatus or LOSSES: Required for all fires if known. Optional 86 ' Ilnvestigate Personnel form is used. for non fires. None PrimaryApparatus Personnel Property $I I , I 0001,1 0001 ❑ Action Taken (1) Suppression ' 1 I I Contents $' ' a ' 000I I000JI I _) riAdditional Action Taken (2) EMS l I I I PRE-INCIDENT VALUE: optional L__J ' _1 Other I 00011 I 0003I Property .$I 1 , 1 0001,1 0 0 0] ❑ Additional Action Taken (3) ® Check box if resource counts include aid received resources. Contents $I I s I 0001,1 0001 ❑ Completed Modules Hl*CasualtiesDNone H3 Hazardous Materials Release I Mixed Use Property ❑Fire-2 Deaths Injuries 14 FjNone NN X Not Mixed ❑Structure-3 Fire 10 Assembly use I I I I 1 L]Natural Gas: slow leak, no evanation or BanEat actions 20 'Education use ®Civil Fire Cas.-4 Service 2 0Propane gas: su lb. tank (as in home BBC)grill) 33 Medical use ❑Fire Serv. Cas.-5 Civilian) I I I 3 ❑Gasoline: vehicle fuel tank or40 Residential use portable container ®EMS-6 4 ❑Kerosene: fuel burning equipment or portable storage 53.. —Row of stores H2 Detector 53 ❑HazMat-7 Enclosed mall Required for Confined Fires. 5 ❑Diesel fuel/fuel oil:vehicle fuel tank or portable 58 --Bus. & Residential ®wildland Fire-8 6�—y'Detector alerted occupants solvents: home/ office spill, cleanup only 59 Office use 1LJ1 Q Apparatus-9 7 0Motor oil: 60 —Industrial use from engine or portable container ®Personnel-10 2®Detector did not alert them 8 ❑paint: from 63 —Military use ❑Arson-11 l_1 paint cans totaling c 55 gallons 65 °Farm use U❑Unknown 0 ❑Other: Special BaeMat actions required or spill > 55ga1., 00 Other mixed use Please complete the BasMat form 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 161 ❑Restaurant or cafeteria 3 61❑Prison or jail, not juvenile 571 ❑Gas or service station 4 19❑ 1-or 2-family dwelling 599 Business office 162 ❑Bar/Tavern or nightclub 429 Multi-famil dwelling 615 ❑Electric generating plant 213 ❑Elementary school or kindergarten 43 9 Rooming/boarding boardin house 215 High school or ® g/ g 62 9 ❑Laboratory/science lab ❑ 5 junior high 449 Commercial hotel or motel 241. ❑College, adult education4590 ❑ 7 00 ❑Manufacturing plant 4 59❑Residential, board and care 819 Livestock/poultry storage(barn) 31.1 ['Care facility for the aged 4 64 Dormitory/barracks ® 882 III Non-residential parking garage 33 1 ❑Hospital 519®Food and beverage sales 891 ❑Warehouse Outside Vacant lot 936 ❑ 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 669 ❑Forest (timberland) 951 Railroad right of wayLookup and enter a Property Use code only if ❑ g you have NOT checked a Property Use box: 807 ['Outdoor storage area 960 ['Other street 919 ['Dump or sanitary landfill Property Use 1340 1 961 ❑Highway/divided highway 931 ❑Open land or field 962 Residential street/driveway (Clinics, doctors offices, ' NFIRS-1 Revision 06/03/05 FIRE RESCUE 07009 02/24/2007 07-0018352 "Xi Person/Entity Involved I I I I - I I I J Local Option Business name (if applicable) Area Code Phone Number I I I I L__l I - I L_J ®Check This Hox if Same address as Mr.,M9., Mrs. First. Name MI Last Name Suffix incidenth location. I I L� I -iI I I L�� Then skip the three duplicate address Number Prefix Street or Highway Street Type lines. Suffix f.ix I I I I I I Post Office Box Apt./Suite/Room City } III I-I I State Zip Code yp ❑More people involved? Check this box and attach Supplemental. Forms (NFIRS-1S) as necessary K2 owner 0 Same as person involved? Then check this box and skip I 1 L -j] - I I- The rest of this section. � JJ Local Option Business name (if Applicable) Area Code Phone Number I I I - i L__. l I -1 L___I 0 Check this box if Mr.,Ms., Mrs. First Name MI Last Name Suffix same address as incident location. I I L�I I J I I LJ Then skip the three duplicate address Number Prefix Street or Highway Street Type Suffix lines. I I I I I J Post Office Box Apt./Suite/Room City II I J- L State Zip Code L Remarks Local Option 303 called to United Medical Park for a notifier alarm. Severe ice storm and all power in the area is out. Upon arrival, the alarm is sounding but saw nothing on an outside walk around. 10-8 @ 18:14 Lt J Ruehs 1 I i . L Authorization I RUEHS,J I IRuehs, Jeff I ILT I I 303 11 021 24 I 20071 Officer in charge ID Signature Position or rank Assignment Month. Day Year Check Box IRUEHS,J I I Ruehs, Jeff I ILT I [ 303 _ I I 021 L241 I 20071 same Position or rank Assignment Month Day Year as officer Member making report ID Signature in charge. FIRE RESCUE 07009 02/24/2007 07-0018352 MI LPJ YYYY ❑Delete NFIRS -1 107009� I IIA I* 102 1124,J I 2007 I 14 I 1 07-0018353 I I 0001 ❑FDID State Incident Date Change Basic Station Incident Number * Exposure Elko Activity BLocation* Module In Section E "Alternative Location Specification". Use only for Wildland fires. t ...,.,_.,,..c‘ensus Tract 10014 l_1 0 0 1 ❑Street address I I ]_ I I (` Intersection Reber 11AVE I 1 Number/Milepost Prefix Street or Highway ❑In front of Street Type Suffix ❑Rear of I I 'Waterloo 111A 1150703 I-1 Apt./suite/Room City State Zip Code ❑Adjacent to ❑Directions Drexel AVE 1 Cross street or directions, as applicable 1 I / =<i" 1; :, Secondary Address C Incident Type * H1 Date & Times Midnight is 0000 E2 Shift & Alarms 1444 I [Power line down I Check boxes if Month Local Option I Type dates are the Day Year Hr Min Sec p same as Alarm ALARM always required D Aid Given or Received* Date. Alarm * I 021 J 241 1 20071117:43:00 1 IC 1 I 01[ If Shift or Alarms District Platoon 1 ❑Mutual aid received 1 lU ARRIVAL required, unless canceled or did not arrive ❑ As rival * 1021 ( 241 I 20071117:50:00I State 3 2 DAutomatic aid recv. Their FDID Their 3 ❑Mutual aid given CONTROLLED Optional, Except for wildland fires Special Studies) 4 ❑Automatic aid given I I ❑Controlled I 021 I 241 I 20071118:01:00 [ Local Option 5 ['Other aid given Their LAST UNIT CLEARED, required except for wildland fires I I Incident Number N NNone Last Unit Special ❑ I 021 I 241 I 20071118:01:00 I study ID# Stud Special Value ,�, Clearedy F Actions Taken * G1 Resources * G2 Estimated Dollar Losses & Values ® Check this box and skip this section if an Apparatus or LOSSES: Required for all fires if known. Optional I$6 1 'Investigate J Personnel form is used. for non fires. None Primary Action Taken (1) Apparatus Personnel Property $1 I , I 0001,1 0001 ❑ Suppression ( 1 1 1 1 I i Contents $1 1 , 1 0001,I ooOJ ❑ Additional Action Taken (2) EMS 1 1 I I PRE-INCIDENT VALUE: Optional 1 11 1 Other I 00011 I 00031 Additional Action Taken (3J Property $1 I , 1 000I,1 0001 ID ❑ Check box if resource counts include aid received resources. Contents $1 1 , I 0001,I 0001 0 Completed Modules H1*Casualties None Mixed Use Property H3 Hazardous Materials Release I ❑Fire-2 Deaths Injuries N In None N X Not Mixed ❑Structure-3 Fire I 2 11 I 1 ❑Natural Gas: 10 Assembly use Slow leak, no evauation Sc HazMat actions ❑Civil Fire Cas.-4 Service ❑ 20 ®Education use Propane gas: <21 lb. tank (as in home HBO grill) 33 tr'Medical use ❑Fire Serv. Cas.-5 Civilian) 11 13 ❑Gasoline: vehicle fuel tank or portable container 40 Residential use ❑EMS-6 TT 4 ❑Kerosene: fuel burning equipment or portable storage 51 Row of stores ❑HazMat-7 H2 k Detector 53 ®_Enclosed mall Required for Confined Fires. 5 ❑Diesel fuel/fuel oil:vehicle fueltan or portable ❑Wildland Fire-8 58 Bus. & Residential 1 Detector alerted occupants 6 ❑Household solvents: home/office spi 59 ®Office use El Apparatus-9 60ll, cleanup only _Industrial use 7 ❑Motor oil: from engine er portable container ®Personnel-10 2❑Detector did not alert them 63 —Military use 8 ❑Paint: free paint cane totaling< 55 gallons ❑Arson-11 u0 unknown O 0 65 Farm use Other: Special Haaliat actions required or Spill . 55gal., 00 "Other mixed use Please complete the HarMat form 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 4 19❑ 1-or 2-family dwelling 599 Business office 162 ❑Bar/Tavern or nightclub 42 9❑Multi-family dwelling 213 ❑Elementary school or kindergarten ❑R 61.5 ID Electric generating plant 4 39 Rooming/boarding house 629 ❑Laboratory/science lab 215 ❑High school or junior high 449 Commercial hotel or motel 241 ❑College, adult education � 7 00 ❑Manufacturing plant 459❑Residential, board and care 819 ❑Livestock/poultry storage(ba.rn) 311 ❑Care facility for the aged 464 Dormitor bk 331 ❑Hospital ❑ �'/ arracs $$2 ❑Non-residential parking garage 519❑Food and beverage sales 891 ❑Warehouse Outside 93 6 ❑Vacant lot 98 1 ❑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 669 ❑Forest (timberland) 951 ['Railroad right of way Lookup and enter a Property Use code only if $O7 ['Outdoor storage area you have NOT checked a Property Use box: 960 pettier street Property Use L962 I 919 ❑Dump or sanitary landfill 961 ❑Highway/divided highway 931 ®open land or field 962 ®Residential street/driveway 'Residential street, road or I NFIRS-1 Revision 06/03/05 FIRE RESCUE 07009 02/24/2007 07-0018353 A MM DD yyyy _______ ❑Delete NFIRS -1 107009 I IIA I I 02 1124I I 2007 I 16 I 107-0018358 I I 0001 ❑change Basic FDID * State* Incident Date * Station Incident Number Exposure p * ❑No Activity w12 w ectn « aa„tai a YPee ®2B LOCat1O1* LModule`In�Sio B�^A�laenver.Lo.rcaauuio'nlpenfiIZion'.',.ueU.s,e, oalp a0for Wuldaan„ fwarev .n'=- t Census Trac 0013 (p, ,q ®Street address I 3207' I I Randolph ' 11ST I L__l ❑Intersection Number/Milepost Prefix Street or Highway g y Street Type Suffix ['In front of ['Rear of I I [Waterloo I IIA I 150702 _I-I I Apt./Suite/Room City State Zip Code ❑Adjacent to I ❑Directions Cross street or directions, as applicable I I 36(i�, Secondary Address Incident * Date & Times TypeMidnight is 0000 El E2 Shift & Alarm? 1445 I 'Arcing, shorted electrical I Check boxes if Month DayYear Hr Min Sec Local Option dates are the IC I I 0 1I I1 Incident Type same as Alarm ALARM always required Aid Given or Received* Date. Alarm * I 021 1 241 I 20071I17:57:00 I DShift or Alarms District Platoon I I ARRIVAL required, unless canceled or did not arrive 1 ['Mutual aid received I IL�J ❑ LEI Arrival * I 02j I 241 I 2007I'18:11:00 I E3 2 Automatic aid recv. Their FDID Their State CONTROLLED Optional, Except for wildland fires 3 ❑Mutual aid given p Special Studies) 4 ['Automatic aid given ' I ®Controlled L 021 I 241 I 2007!'18:11:00 I Local Option 5 ['Other aid given Their LAST UNIT CLEARED, required except for wildland fires I I (_ IQ None Incident Number Last Unit Special Special ❑ ® Cleared I 021 I 24' I 2007I118:11:00 I Study IN( Study Value F. Actions Taken * GI Resources * G2 Estimated Dollar Losses & Values I Check this box and skip this LOSSES: Required for all fires if known. Optional section if an Apparatus or q 1 for non fires. None I00 I 'Action taken, Other I Personnel form is used.Apparatus Personnel Property $I 1 , I 0001,1 0001 ❑ Primary Action Taken (1) Suppression I I I I Contents $I 1 , 1 0001,1 0001 El II I I Additional Action Taken (2) EMS ( I I I PRE-INCIDENT VALUE: Optional I I I .] Other ' 00011 I 00031 Property $I I , I 0001,1 000j ❑ Additional Action Taken (3) ❑ Check box if resource counts include aid received resources. Contents $I I , I 0001,1 00(J ❑ Completed Modules Hl,A:C ® Mixed Use Property None H3 Hazardous Materials Release I ❑Fire-2 Deaths Injuries IsT n None NTT XNot Mixed ❑Structure-3 Fire 10 Assembly use I I I I 1 Natural Gas: sloe,leak, no evsaation or Ha=seat actions 20 Education use Service ['Civil Fire Caa.-4 2 ❑Propane gas: <21 lb. tank (as in home sae grill) 33 Medical use ❑Fire Serv. Cas.-5 I II I ['Gasoline: or 40 --Residential Residential use Civilian! 3 vehicle fuel tank o table container ['EMS-6 4 ❑Kerosene: fuel burning equipment Srportable storage 51 Row of stores ®HazMat-7 H2 Detector 53 Enclosed mall Required for Confined Fires. 5 ['Diesel fuel/fuel Oil:vehicle fuel tank or portable 58 —Bus. & Residential ❑Wildland Fire-8 if 'Detector alerted occupants 6 ❑Household solvents: home/office spill, cleanup only 59 ®Office use El Apparatus-9 LI 7 ]Motor oil: from engine or portable container 60 Industrial use ®Personnel-10 20netector did not alert them an 63 Military use 8 ❑Paint: from paint cane totaling< 55 gallons r 65 Farm use ❑Arson-11 unknown ® ❑Other: Special Haeliat actions required o spill a 55ga1., 00 --Other mixed use ..- Please complete the Hatliat form -- 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 Prison or ail, notjuvenile 361❑ j 571 ['Gas or service station 163. ❑Restaurant or cafeteria 4 l9❑ 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 4 3 9❑Rooming/boarding house 629 ❑Laboratory/science lab 215 ['High school or junior high 449 Commercial hotel or motel ❑ 700 ['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 4 891 ❑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 669 Forest (timberland) Lookup and enter a Property Use code only if 951 ❑Railroad right of way you have NOT checked a Property Use box: 807 ['Outdoor storage area 960 ❑Other street Property Use I938 I . 919 ❑Dump or sanitary landfill 961 ❑Highway/divided highway 931 ❑Open land or field 962 ['Residential street/driveway !Graded and cared-for plots NFIRS-1 Revision 06/03/05 FIRE RESCUE 07009 02/24/2007 07-0018358 MM DD YYYY —107009 I I IA I I 02 1 1 241 1 2007 5 I1 I ❑❑Delete NFIRS -1 FDID I I 1 107-0018365000 State Change Basic * Incident Date * Station Incident Number Exposure ❑No Activity ,elz �.x 1.,u�'a�e a tlu 'ne�w.Lu,au" ,B Location* LJ Moeule`In''S'Ztion B "Alternative`LocationsSpeCification"luUse onlytfor°Wileland fires. Census Tract 1000$ _ ,yo ®Street address V El Intersection L 6371 I 'Wyoming I Number/Milepost Prefix Street or HighwayI IST I L-.J ®In front of Street Type Suffix ®Rear of L I [Waterloo i l_p__Ii 150703 I Le ['Adjacent to Alt./suite/Room city State zip Code Directions ®� Cross street or directions, as applicable _ 1 fp' f" Secondary Address �'� (r' Incident Type �k Midnight is 0000 444 1 El Date & Times E2 Shift & Alarm (Power line down Check boxes if IncidentType - dates are the Month Da Local Option y Year Hr Min Sec same as Alarm ALARM always required IC I I 01115 n Aid Given or Received* Date. Alarm * 1 021 1241 1 20071117:59:001 Shift or Alarms District ARRIVAL required, unless canceled or did not arrive 1 ❑Mutual aid received Platoon (Their FDID III 0 Arrival * 1 021 1 241 1 20071118:03:00 1 3 2 ❑Automatic aid recv. 3 ❑Mutual aid given CONTROLLED Optional, Except for wildland fires Special Studied 4 [ Automatic aid given 1 1 ❑Controlled I 021 I 241 1 2007111$:09:00_I Local Option 5 ❑Other aid given Their LAST UNIT CLEARED, required except for wildland fires I 1 N ®None Incident Number Last UnitSpeci 1� ❑ 1 021 I 241 1 20071118:09:00 I study IN Study Value Clearedl F Actions Taken* G1 Resources it G2 Estimated Dollar Losses & Values ® Check this box and skip this section if an Apparatus or LOSSES: Required for all fires if known. Optional 186 1 'Investigate 1 Personnel form is used. for non fires. None Primary Action Taken (1) Apparatus Personnel Property $1 1 , 1 0001,1 0001 ❑ I 1 1 Suppression 1 1 1 _ 1 I Contents $1 1 , 1 000_1 ,I 0001 Additional Action Taken (2) EMS 1 I I PRE-INCIDENT VALUE: Optional ___I Other 1 000111 00031 Additional Action Taken (3) Property $1 1 , 1 0001,1 00J ❑ ❑ Check box if resource counts include aid received resources. Contents $1 1 f 1 0001,1 0001 ❑ Completed Modules Hi*Casualties❑None H3 Hazardous Materials Release I Mixed Use Property ❑Fire-2 Deaths Injuries N El None NN X Not Mixed ❑Structure-3 Fire I 11 10 Assembly use 1 1 ❑Natural Gas: slow leak, n evauatios or HazMat actions ❑Civil Fire Cas.-4 Service o 2 0 ®Education use 2 Propane gas: 021 lb. tank (as in home HBO grill) 33 ®Medical use ❑F'ire Serv. Cas.-5 II ❑EMS-6 Civilian) I 3 ❑Gasoline: vehicle fuel tank or portable container 40 Residential use ❑HazMat-7 H2 Detector 4 ❑Kerosene: fuel earning equipment or portable storage 51 ®Row of stores Required for Confined Fires. 5 ❑Diesel fuel/fuel oil:vehicle fuel tank or portable 53 Enclosed mall ❑Wildland Fire-g 58 --Bus. & Residential 1Liretector alerted occupants 6 LiHousehold solvents: home/office spill, cleanup only 59 Office use ®Apparatus-9 7 ❑Motor oil: from engine or portable container 60 Industrial use ®Personnel-10 20Detector did not alert them 8 ❑Paint: from ®Arsonne an 63 —Military use paint cans totaling < 55 gallons U unknownEl Farm use 0 Other: special Haztdat actions requires or spill > ssgal., Please complete the HaeMat form 0® ''Other mixed use J Property Use* Structures 341❑Clinic,clinic type infirmary 539 ❑Household goods,sales,repairs 342❑Doctor/dentist office 579 ❑Motor vehicle/boat sales/repair 133. ❑Church, place of worship 3 6 1❑Prison or jail, not juvenile 571 ❑Gas or service station 161 ['Restaurant or cafeteria 4 19❑ 1-or 2-family dwelling 599 ❑ Business office 162 ['Bar/Tavern or nightclub 2 13 Elements 429❑Multi-family dwelling 615 ❑Electric generating plant ❑ ry school or kindergarten 43 9❑Rooming/boarding house 629 Laboratory 215 ❑High school or junior high ❑Laboratory/science lab 449❑Conanercial hotel or motel 700 0 Manufacturing plant 241 ❑College, adult education 459®Residential, board and care 819 ['Livestock/poultry storage(barn) 311 ['Care facility for the aged 4 64❑Dormit /b oryarracks ❑Non-residential ®Hospital 882 parking garage 331 519❑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 669 ['Forest (timberland) 951 ['Railroad right of way Lookup and enter a Property Use code only if you have NOT checked a Property Use box: 807 ❑Outdoor storage area 960 ®Other street 1 ['Dump Dump or sanitary landfill Property Use 1962 961 ❑Highway/divided highway 931 ❑Open land or field 962 ®Residential street/driveway (Residential street, road or 1 NFIRS-1 Revision 06/03/05 FIRE RESCUE _ 07009 02/24/2007 07-0018355 ;IC1 Person/Entity Involved ( J I I II Local Option Business name (if applicable) Area Code Phone Number I I I I I® _J I I L� Check This Box if same address as Mr•.Ms., Mrs. First Name MI Last Name incident location. I I I I Suffix Then skip the three I I ( U duplicate address Number lines. Prefix Street or Highway Street Type Suffix ost Office Box I A pt./Suite/Ro m City U I I-I I • State Zip Code ®Dore people involved? Check this box and attach Supplemental Forms (NFIRS-1S) as necessary IC2 Owner 1� Same as person involved? `� u Then check this box and skip I I I I - The rest of this section. Local Option Business name (if Applicable) Area Code Phone Number .. I I I 1 1MI I U 0 Check this box if Mr.,Ms., Mrs. First Name MI Last Name same address as Suffix incident location. I I I I Then skip the three I I L� duplicate address Number Prefix Street or Highway lines. Street Type Suffix Post Office Box I Apt./Suite/Ro i (City I_J I J-I I State Zip Code ____ _. -ems L Remarks _. Local Option Dispatched for downed wire. Nothing found. I i . . t • s I I I L Authorization = ILILJA,P I I Lilja, Pete ( IALT I I I ( 021 12411 2007 � Officer in charge ID Position or rank I g Signature Assignment gn Month Day Year Check Box if® I LILJA,P I I Lilja, Pete I IALT I I I I 021 124I I 20071 same as O€ficer Member making report ID Signature Position or rank Assignment Month Day Year in charge. FIRE RESCUE 07009 02/24/2007 07-0018365 LAMM DD YYYY 11]J I I 4l I 2007 6Delete 0700 IA 02 2I I 107-0018367 I I 0001 ❑ NFIRS -1 FDID State Incident Date Change Basic Station Incident Number * Exposure ®No Activity ..uc�� ,.ua st w ruur�oic u.eu u,e a s.ee' lr ..._. • _.. ... B Location* Module In Section H ^Alternative 7ocatlon Specif cation". ose only far Wildland frres. a,„_...--Census Tract 0010 Q ®Street address (t L 6091 I I (Hammond I [VE I I ['Intersection Number/Milepost Prefix Lh P Street or Highway ['In front of Street Type Suffix ❑Rear of L I (Waterloo I 'IA I 150702 I-I I ❑Adjacent to Alt./suite/Room City State Zip Code ❑Directions Cross street or directions, as applicable L I _,., ,-V O,v Secondary Address T C Incident Type * El Date & Times Midnight is o000 E2 Shift & Alarm- 1444 I (Power line down I Check boxes if Incident Type dates are the Month Day Year Hr Min Sec Local Option same as Alarm ALARM always required IC I I oil I1 D Aid Given or Received* Date. Alarm * I 02i I 241 1 2007II18:25:00 I Shift or Alarms District Platoon 1 ❑Mutual aid received I II_____J ARRIVAL required, unless canceled or did not arrive Arrival I 02I I 24I I 2007I I18:29:®O I E3 2 ❑Automatic aid racy. Their FDID Their 3 ❑Mutual aid given State CONTROLLED Optional, Except for wildland fires Special Studies)4 ❑Automatic aid given I I EIControlled I 021 I 24I I 2007I119:40:00 I Local Optionp ['Other Other aid given Their LAST UNIT CLEARED, required except for wildland fires I I L . N ®None Incident Number Last Unit III Cleared 102I 124I I 2007II19:40:00 I Special Special Study F. Actions Taken * Gl Resources * G2 Estimated Dollar Losses & Values ® Check this box and skip this section if an Apparatus or LOSSES: Required for all fires if known. Optional 190 I (.Fill-in, standby, Other I Personnel form is used. for non fires. None Primary Action Taken (1) Apparatus Personnel Property $1 I s I 000I,I 00pj CI Suppression I I I 182 I (Notify other agencies. ( Content' $I IfI OOOI,I OOOJ Additional Action Taken (2) I EMS I I I I PRE-INCIDENT VALUE: Optional I I I I Other I 00011 I 00031 Additional Action Taken (3) Property $I I , I 0 0 Q I,I ©®J ® Check box if resource counts include aid received resources. Contents $I I , I 000I sI 0001 Ei Completed Modules Hl*CasualtiesEINone Hazardous Materials Release Z I�3 Mixed iYse Property 0Fire-2 Deaths Injuries N ®None NAj ]; Not Mixed Structure-3 Fire I I I 11 ❑Natural Gas: 10 Assembly use Service slow leak, no sensation or HarMat actions ❑Civil Fire Cas.-4 20 .m Education use 2 0 Propane gas: 421 lb. tank (as in home ee4 grill) 33 Medical use ❑Fire Serv. Cas.-5 Civilian) II I 3 ❑Gasoline: vehicle fuel tank or portable container 40 _Residential use ❑EMS-6 ❑E0dS-6 -7 2 Detector 4 ❑Kerosene: fuel burning equipment or portable storage 51 Row of stores Re5 Diesel fuel fuel oil:,,' 53 Enclosed side Required for Confined Fires. ❑ / hicle fuel tank or portable ❑Wildland Fire-8 58 —Bus. & Residential l❑Detector alerted occupaata 6 ❑Household solvents: home/office spill, cleanup only 59 —Office use ®Apparatus-9 7 ❑Motor oil: from engine or portable container 60 Industrial use ®Personnel-10 20Detectordid not alert them 63 Military use ❑Arson-11 8 ['Paint: from paint cans totaling c 55 gallons -il U Unknown ❑ 65 Farmte use ❑ 0 Other: Special completeaa.liat ache Ha required or spill , SSgal., ®® Other mixed use Please the HarMat form — 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 361111Prison or jail, not juvenile 571 ❑Gas or service station 161 ❑Restaurant or cafeteria 41.90 1-or 2-family dwelling 162 ❑Bar/Tavern or nightclub 599 El Business office 429❑Multi-family dwelling 615 ❑ Electric generating plant 213 ['Elementary school or kindergarten 439❑Rooming/boarding house 629 ❑Laboratory/science lab 215 0 High school or junior high 449❑Commercial hotel or motel 700 ❑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 331 ❑Hospital $$2 ❑Non-residential parking garage 519 0 Food and beverage sales 891 ❑Warehouse Outside 936 ❑Vacant lot 981 0 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 669 ®Forest (timberland) 951 ❑Railroad right of way Lookup and enter a Property Use code only if you have NOT checked a Property Use box: 807 0 Outdoor storage area 960 ['Other street Property Use 1962 I 919 ❑Dump or sanitary landfill 961 ❑Highway/divided highway 931 ❑Open land or field 962 ®Residential street/driveway (Residential street, road or I NFIRS-1 Revision 06/03/05 FIRE RESCUE 07009 02/24/2007 07-0018367 K i Person/Entity Involved I I I I - I I_I_____-___J Local Option Business name (if applicable) Area Code Phone Number I I I I I ( I I L-J ❑Check This Box if Same address as Mr.,Ms., Mrs. First Name MI Last Name incident location. Suffix Then skip the three I I LJ duplicate address Number lines. Prefix Street or Highway Street Type Suffix I Post Office Box A pt./Suite/Ro I I City I II I I-I I State Zip Code More people involved? Check this box and attach Supplemental Forms (NFIRS-1S) as necessary K2 owner 0 Same as person involved? Then check this box and skip I I ( I - The rest of this section. I-I Local Option Business name (if Applicable) Area Code Phone Number I I [ I L _J I l L___J Check this box if Mr.,Me., Mrs. First Name MI Last Name Suffix same address as II ' incident location. I I L� I I I I ( I Then skip the three duplicate address Number Prefix Street or Highway Street Type Suffix lines. I 1 1 I Post Office Box Apt./Suite/Room City L-J I - I I State Zip Code L Remarks Local Option Responded to down power line. Notified and stood by for MidAmerica to take over scene. ) kki f�f `I 1 ) L Authorization IMOORE,M I ' Moore, Michael I ILT I 1306 I I 021 124I I 20071 Position or rank Assignment Month Day Year Officer in charge ID Signature Check Box if® I MOORE,M I (Moore, Michael I ILT I 1306 I I 021 124I I 20071 same as Officer Member making report ID Signature Position or rank Assignment Month Day Year in charge. FIRE RESCUE 07009 02/24/2007 07-0018367 MM DD YYYY _ 107009 I IIA I I 02 ❑Delete NFIRS -1 1 241 I 2007 1 15 1 1 07-0018369 l I 0001 FDID * State* Incident Date ❑Change Basic * Station Incident Number * Exposure ❑No Activity BLocation* LJ Modul e`I n'Se ct i en B^Alt a:na"t ive LLocat ion sSpe c ficat ion1LLOse y p1 Vy11cu uu n., Tr'ids.auu .i. 10008 Q 0 0 O J-�Q Q only Eor wildlandefires. Census Tract 9 Street address / _ 1 I 5001 I I lskyvi 4 ew i Intersection Imp I L__J Number/Milepost Prefix Street or Highway ❑In front of Street Type Suffix ❑Rear of I I (Waterloo 1 .121LJ 150703 I-L__-__J Apt./Suite/Room City State [�Adjaeent to I zip Code ❑Directions Cross street or directions, as applicable L ,-..-----Rro Secondary Address c Incident Type * El Date & Times Midnight is 0000 E2 Shift & Alarm (Power line down I Check boxes if Month Da Local Option I 444 1 Incident Type dates are the }' Year Hr Min SeC same as Alarm ALARM always required D Aid Given or Received* Date. Alarm * 1 021 1 241 1 20071118:16:00 I hi I I ®lI 1.!.;Shift or Alarms District � I ARRIVAL required, Platoon 1 Mutual aid received 1 Ili unless canceled or did not arrive 2 ❑Automatic aid recv. Their Polo Their State ❑ Arrival 1 021 1 241 I 20071118:28:00I �r 5�y3 3 []Mutual aid given CONTROLLED Optional, Except for wildland fires Special Studies) 4 ❑Automatic aid given 1 J OControlled I 021 1 2411 20071118:36:00 I Local Option 5 ❑Other aid given Their LAST UNIT CLEARED, required except for wildland fires I-__,___J I N None Incident Number Last Unit 021 1 241 I 20071118°36.00 1 Study ID# Special �� Cleared Y Study Value F Actions Taken Gl Resources G2 Estimated Dollar Losses & Values giCheck this box and skip this �' section if an Apparatus or LOSSES: Required for all fires if known. Optional 186 I Il:nvestigate I Personnel form is used. for non fires. None Primary Action Taken (1) —J Apparatus Personnel Property $1 1 , 1 0001,1 0001 ❑ I I I__ 1 Suppression I I I I Contents $1 1 , I_ 0001,1 00(J f� Additional Action Taken (2) EMS I 1 I I 1 LJ PRE-INCIDENT VALUE: optional I I L I Other I 00011 1 00031 Additional Action Taken (3) Property $I 1 , I 0001,1 0001 ❑ Check box if resource counts include aid received resources. Contents $1 1 s 1 0001,1 009.1 ❑ Completed Modules Hi*Casualties ❑None H3 Hazardous Materials Release Y Mixed Use Property 0 Fire-2 Deaths Injuries N ❑S None NN X Not Mixed (]Structure-:i Fire 1 II10 Assembly use I 1 ['Natural Gas: slow leak, no evauation or Ha=Hat actions ❑Civil Fire Cas.-4 Service 20 Education use 2 ❑Propane gas: <21 lb. tank (as in home HBO grill) 33 —Medical use ❑Fire Serv. Cas.-5 Civilian) I I 1 3 []Gasoline: vehicle foal tank or portable container 40 Residential use ®EMS-6 H2 Detector 4 ❑Kerosene: fuel burning equipment or portable storage 51 Row of stores ❑HazMat-7 5 ❑Diesel fuel/fuel oil: e 53 Enclosed mall Required for Confined Fires. hide fuel tank OWildland Fire-8 or portable 58 Bus. & Residential 1®Detector.alerted occupants 6 ['Household solvents: home/office spill, cleanup only 59 'Office use ®Apparatus-9 7 [praetor Motor oil: from engine or portable container 60 Industrial use 0Personnel-3.0 2❑Detector did not alert them 63 Military use Paint: from paint cans totaling< 55 gallons ❑Arson-11 U unknown ❑ or 65 Farm use ❑ 0 Other: special Haplet actions requiredspill > ssgal., 00 Other mixed use Please complete the HazMat form _ J Property Use* Structures 341❑Clinic,clinic type infirmary 53 9 ❑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 4 19❑ 1-or 2-family dwelling 899 ❑ Business office 162 ❑Bar/Tavern or nightclub 2 13 ®Element:ary school or kindergarten 4290 Multi-family dwelling 615 ❑Electric generating plant 439❑Rooming/boarding house 629 Laborator 2 15 ❑High school or junior high ❑ y/science lab 449❑Commercial hotel or motel 700 ❑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 ['Non-residential parking garage 331 ❑Hospital 882 _ 519❑Food and beverage sales 891 0 Warehouse Outside 936 ❑Vacant lot 981 ❑ Construction site 124 ❑Playground or park 938 ❑Graded/care for plot of land 984 ❑ Industrial plant yard 655 G]cropa or orchard 946 ❑Lake, river, stream 669 [Forest (timberland) 951 ❑Railroad right of way Lookup and enter a Property Use code only if 807 ❑Outdoor storage area you have NOT checked a Property Use box: 960 ❑Other street 919 ❑Dump or sanitary landfill Property Use [962 I 961 ❑Highway/divided highway 931 ❑Open land or field 962 Residential street/driveway (Residential street, road or 1 NFIRS-1 Revision 06/03/05 FIRE RESCUE _ 07009 02/24/2007 07-0018369 A MM DD YYYY 107009 IA I I 1 1 02 1 L24I 1 2007 ) I I4 I I07-0018370 I I 000 ❑Delete State* Incident Date lQFIRS -1 * Station Incident Number ❑Change Basic FDID y� * Exposure * �,an,n ❑No Activity B "` iYk iv a„ a�aie �na' i,R �uua.,en ya Jva u�u „u,il.lra auaa„4,aa� Location* Li Module In Section B ^Alternative Location Specification. Use only for Wi ldland fires. Census Tract I0011 ®Street address ❑IntersectionI 14001 I I (Denver n I 1ST Number/Milepost Prefix Street or Highway MIn front of Street Type Suffix ❑Rear of I I (Waterloo I IA I50703 Apt./suite/Room City . _I® �, ❑Adjacent to I State Zip Code ❑Directions Cross street or directions, as applicable Secondary Address Incident Type * Date & Times Midnight is 0000 I 444 1 E1 �2 Shift & Alarm(Power line down I Check boxes if Incident Type dates are the Month Day Year Hr Min Sec Local Option same as Alarm ALARM always required C, D Aid Given or Received* Date. Alarm * I 021 J 24I I 2007II18:11:00 I I I I 011 19 Shift or Alarms District 1 ®Mlltllal aid received ARRIVAL required, Platoon I unless canceled or did not arrive I I 2 DAutomatic aid recv. Their FDID Their ❑ Arrival * I 021 I 2411 2007I I18:25:00 3 Mutual aid State 3 ® given CONTROLLED Optional, Except for wildland fires Special Studies 4 ❑Automatic aid given I J ❑Controlled I 021 I 2411 20071118:34:001 Local Option 5 ❑Other aid given Their LAST UNIT CLEARED, required except for wildland fires I I I Incident Number N ®None Last Unit Special I 02I I 24I 2007I I18:34:00 I study ID$ SttudlaY Value ID Cleared F Actions Taken * G1 Resources * G2Estimated Dollar Losses & Values la] Check this box and skip this L1 section if an Apparatus or LOSSES: Required for all fires if known. Optional for non fires. I45 I IFtem®ve hazard I Personnel form is used. None Primary Action Taken (1) Apparatus Personnel Property $I I , I 0001,1 0001 ❑ I I I Suppression Contents $I 1 , 1 00Old 000� ❑ Additional Action Taken (2) I EMS PRE-INCIDENT VALUE: Optional I I I I Other I 000111 00031 Additional Action Taken (3) Property $1 I a 1 0001,1 00(_1 ❑ ❑ Check box if resource counts include aid received resources. Contents $I I , I 0001,1 000] ❑ Completed Modules jai*Casualties❑None H3 Hazardous Materials Release I Mixed Use Property 0Fire-2 Deaths Injuries N nNone NN X Not mixed 0Structure-:3 Fire I I I 10 Assembly use I1 ❑Natural Gas: slow leak, no evocation or Bardiat actions ❑Civil Fire Cas.-4 Service "a 2 Q Education use 2 ['Propane gas: <21 lb. tank (as in home HBO grill) ❑Fire Serv. Cas.-5 33 Medical use Civilian) I I 13 ❑Gasoline: vehicle fuel tank ❑EMS-6 or portable container 40 Residential use H2 Detector 4 ❑Kerosene: fuel burning equipment or portable storage 51 a Row of stores ❑EMS-6 -7 53 Enclosed mall Required for Confined Fires. 5 ®Diesel fuel/fuel Oil:vehicle fuel tank❑Wildland Fire-8 or portable 58 —Bus. & Residential 1®Detector alerted occupants 6 ❑Household solvents: hoeeioffice spill, cleanup only 59 Office use ®Apparatus-9 7 ❑Motor oil: from engine or portable container 60 Industrial use ®Persol-10 2❑Detector did not alert them — Arson-11 0Other: D Paint: from 63 Military use paint cans totaling< 55 gallons U Unknown065 Farm use Special Baplet actions required or spill s 55ga1., 00 Other mixed use Please complete the BazMat form _ 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 161 ❑Restaurant or cafeteria ❑ or jail, not juvenile 571 ID Gas or service station 419® 1-or 2-family dwelling 599 0 Business office 162 ❑Bar/Tavern or nightclub 213 ®Elementary school or kindergarten 429❑Multi-family dwelling 615 0 Electric generating plantb 4390Rooming/boarding house 629 Laboratory/science❑High school or junior high ❑ lab 449❑Commercial hotel or motel 700 ❑Manufacturing plant 241 0 College, adult education 459❑Residential, board and care 819 ❑Livestock/poultry storage(barn) 311 ❑Care facility for the aged 464 331 ❑Hospital ❑Dormito ry/barracks 882 ❑Non-residential parking garage 519 0 Food and beverage sales 891 ['Warehouse Outside 936 ❑Vacant lot 981 El Construction site 124 ❑Playground or park 938 ❑Graded/care for plot of land 984 0 Industrial plant yard 655 ❑Craps or orchard 946 ❑Lake, river, stream 669 ['Forest (timberland) 951 ❑Railroad right of way Lookup and enter a Property Use code only if you have NOT checked a Property Use box: 807 ❑Outdoor storage area 960 ❑Other street Property Use 1419 i 919 ❑Dump or sanitary landfill 961 ❑Highway/divided highway 931 ®Open land or field DResidential 962 Residential street driveway 11 or 2 family dwelling I NFIRS-1 Revision 06/03/05 FIRE RESCUE - - -- 07009 02/24/2007 07-0018370 K:1 Person/Entity Involved II I I I ( I__________1 ( Local Option Business name (if applicable) Area Code Phone Number Check This Sox if I I I I l�J I I �, I Mr.,Ms., Mrs. First Name same address as MI Last Name Suffix incident location. Then skip the three I 1 I 1 I I I I duplicate address Number lines. Prefix Street or Highway Street Type Suffix I I Post Office Box Alt./Suite/Ro I City III I-I I State zip Code More people involved? Check this box and attach Supplemental Forms (NFIRS-1S) as necessary K2 Owner 11 Same as person involved? Then check this box and skip I I I I - The rest of this section. I-�- Local Option Business name (if Applicable) Area Code Phone Number 1 i t I I l l_J Check this if Mr.,Ms., Mrs. `First Name MI Last Name same addresss as Suffix incident location. I I ' Then skip the three �_) duplicate address Number Prefix Street or Highway lines. Street Type Suffix Post Office Box I Alt./Suite/Ro m I ity II 1-I I State Zip Code .. ......_ ... .__ _ .vim _. ... — L Remarks Local Option Respond to a report of a power line down. Arrived on scene and investigated to find a cable tv entrance cable down. Cut and removed from roadway. 1 i ) 3Y L Authorization _ "— ( I IFRESHWATER,M I ( Freshwater, Marty I ILT I I304 I I 021 1241 I _20071 Position or rank Assignment Month Day Year Officer in charge ID Signature Check Box if® I FRESHWATER,M I !Freshwater, Marty I ILT I 1304 I I 021 24 I 20071 same as Officer Member making report ID Signature Position or rank Assignment Month Day Year in charge. FIRE RESCUE 07009 02/24/2007 07-0018370 A MM DD yyyy 7009 1 IA 1 02 i 1 241 I 2007 L 1 107-0018383 ❑Change FDID ,* State* Incident Date I 1 000 I b1FIRS -1 Station Incident Number DChange * Basic __.__..._._._ _.... ,_,. sure EllExpo B No Activity Location* ■Module In Section 9 :Alternative Location S peci fi Ca Cion'. Use only. Eor Wildland fares... tres ,Census Tract 0015 03 ®Street address L F ['Intersection 6471 1 1 'Maxwell ' Number/Milepost Prefix Street or Highway I 't I I ['In front of Streeteet Typee Suffix ['Rear of L I iWaterlo0 1 I 50703['Adjacent to Apt./Suite/Room city IA ' I�_____I-1 ' State Zip Code ['Directions Cross street or directions, as applicable Secondary Address i Mid1 ,aG::. , �' c Incident Type Midnight is o000 < El Date & Times E2 Shift & Alarms 1412 I 'Gas leak (natural gas or LPG) I Check boxes if Year Incident Type dates are the Month Da Local Option same as Alarm ALARM always required y Hr Min 52C IC D Aid Given or Received I )— ( 1 oil 14 Date. Alarm * 021 24 1 20071118:35:00 1 Shift or Alarms District 1 ['Mutual aid received I II ARRIVAL required, unless canceled or did not arrive Platoon 2 Automatic aid recv. Their FDID Their ❑ Arrival * I 021 I 241 1 20071118:40:00 3 ['Nlutual aid given State ' �3 CONTROLLED Optional, Except for wildland fires 4 ['Automatic aid given ISpecial Option sl I ❑Controlled I 02I I 241 I 20071118:54:001 Local Option 5 ['other aid given Their LAST UNIT CLEARED, required except for wildland N ®None Incident Number Last Unit fires I 1 le ❑ Cleared I 021 I 241 I 20071118:54:00 ' scUayaiDu ppeccialalue F. Actions Taken * Study G1 Resources G2 Estimated Dollar Losses ElCheck this box and skip this Se Values 164 I 'Shut downsystemsection if an Apparatus or LOSSES: Required for all fires if known. Optional I Personnel form is used. for non fires. Primary Action Taken (1) Apparatus Personnel None SuppressionProperty $`1 1 , 1 0001,1 000' 0 I 1 1 I I ai Contents $1 1 , 1 0001,1 pool Additional Action Taken (2) EMS I 1 1.--' PRE-INCIDENT VALUE: Optional L— I I Other 1 00011 I 00031 Additional Action Taken (3) Property $I I s 000 ,I riCheck box if resource counts L 0®O1 l include aid received resources. Contents $ , 1 0001,1 0001 ❑ Completed Modules H1*Casualties None ® H3 Hazardous Materials Release I Mixed Use Property ❑Fire-2 Deaths Injuries N EINone ❑Structure-3 Fire P 1�JC Not Mixed ['Civil Fire Cas.-4AssemblyService 1 J ' I 1 ['Natural Gas: elow leak, no evauetion or HaeEet actions 10 —Education use 2 ['Propane gas: 20 Education use ['Fire Serv. Cas.-5 1 1 �21 lb. tank (as in home sa4 grill) 33 '�Medical use Civilian' I 3 ['Gasoline; []EMS-6vehicle fuel tank or portable container 40 Residential use ['HazMat-7 H2 Detector 4 0 Kerosene: fuel burning equipment or portable storage 51 Row of stores Required for Confined Fires. 5 ®Diesel fuel/fuel Oil:ve 53 Enclosed mall. ['Wildland Fire-8 :vehicle fuel tank or portable 58 Bus. & Residential Apparatus-9 1❑Detector alerted occupants 6 ❑Household solvents: home/office spill, cleanup only 59 —Office use ®Personnel-10 20Detector did not alert them 7 Motor oil: from engine or portable container 60 —Industrial use ['Arsonnne 8 ['Paint: from paint cans totaling c 55 gallons 63 FMilitaryre use U['Unknown ['Other: 65 Farm use Q�®- 0 ['Other: Special Ha:Mat actions required or spill > ss l., ga 00 Other, mixed use Property Please complete the HazMat form J Use* Structures 3410 Clinic,clinic type infirmary 539 Household 342 Doctor/dentist ❑ goods,salea,repairs 131 ['Church, place of warship ®Doct / entist office 579 ❑Motor vehicle/boat sales/repair 161 ❑Restaurant or cafeteria 3610 Prison or jail, not juvenile 571 0 Gas or service station 419 162 ['Bar/Tavern or nightclub ® 1-or 2-family dwelling 4290 Multi-family dwelling 599 Business office 213 Ill Elementary school or kindergarten 439❑ 6Rooming/boarding house 629 0 Electric g/ enc plant 215 OHigh school or junior high 9 Laboratory/sscciencee lab 241 ❑College, adult education 44910 Commercial hotel or motel 459['Residential, board and care 700 0 Manufacturing plant 311 ®Care facility for the aged 819 ['Livestock/poultry storage(barn) 331 ®Hospital 464❑Dormitory/barracks 882 ❑Non-residential parking garage 5190 Food and beverage sales Outside 891 ID Warehouse 124 ['Playground or park 936 ['Vacant lot 981 ['Construction site 655 ['Crops or orchard 938 ❑Graded/care for plot of land 984 El Industrial plant yard 946 ['Lake, river, stream 669 ❑Forest (timberland) 807 ['Outdoor storage area 951 ['Railroad right of way Lookup and enter a Property Use code only if 960 ❑Other street you have NOT checked a Property Use box: I 919 ['Dump or sanitary landfill Property Use 1419 961 ]Highway/divided highway 931 ®Open land or field 962 ['Residential street/driveway 11 or 2 family dwelling I `--- NFIRS-1 Revision 06/03/05 FIRE RESCUE 07009 02/24/2007 07-0018383 IC1 Person/Entity Involved I I 1319 I - 1 610 I-I 9054 Local Option Business name (if applicable) Area Code Phone Number I I (Donna ( I I IMangrich I I I IACheck This Box if Same address as Mr.,Ma., Mrs. First Name MI Last Name I incident location. I Suffix 4 Then skip the three 647 I I I (Maxwell • duplicate address Number I I SST treet Type Suffix (Waterloo ( Post Office Box Apt./Suite/Room City I IIA I 150703 I-I I State Zip Code fl More people involved? Check this box and attach Supplemental Forms ((FIRS-1S) as necessary K2 Owner El Same as person involved? -`� Then check this box and skip I The rest of this section. J _ I Local Option Business name (if Applicable) ---I - I I I Area C de Phone Number I I I Jul ❑ Check this box if Mr.,Ms., Mrs. First Name I I�J same address as MI Last Name incident location. I II I Suffix Then skip the three I t--r_J I I I I U duplicate address Number Prefix Street or Highway lines. Street Type Suffix Post Office Box Apt./Suite/Room I City I I . _J-I I State Zip Code I, Remarks —..—_ Local Option Respond to a report of a gas leak in the basement of the residence. Arrived on scene and investigated to find a clothes dryer that had malfunction in the basement. Did not go on lock out when it had failed to ignite. Shut gas off to the appliance, ventilate and advise occupant to call a serviceman. f ( 1 I �, Authorization ���� � I FRESHWATER,M I ' Freshwater, Marty I 1LT I 1304 I I Day I 20071 Officer in charge ID Signature Position or rank Assignment Month Day Year Check Box if® I FRESHWATER,M I 'Freshwater, Marty ILT I I304 I I 021 24 I 2007Isame as Officer Member making report ID Signature Position or rank Assignment Month Day Year in charge. I I FIRE RESCUE 07009 02/24/2007 07-0018383 YYY 107009 _I lIA 1 I 02 ( I a4J J Y2007 J l4 J 07-00183$2 000 ❑Delete NFIRS -1 FDID State 1 I 1 * Incident Date Chan e 7� Station Incident Number * Exposure Basic } iL„e�x ,ticx „7„v,�„�e �t,a� Elko Activity Location* Module za section H e „` a°ie" ,.. e„ ., p. ,, ° ,, „ "Alternativ `Location SpeciEicetion°.'Use only for'Wildlandcfires. Census Tract 0 0 1 5 a ®Street address F03 _ 1 6341 Is I !Hackett '0 Intersection Number/Milepost Prefix Street or s J 'RD 1 I J Highway ❑In front of Street Type Suffix ❑Rear of I J 'Waterloo I JIA ' 150703 ! Adjacent to Apt./suite/Room City State Zip Code ❑Direct ions 1. Cross street or directions, as applicable I f$; 4/ Secondary Address �.. '`'� incident Type Date & Times Midnight is 0000 I �1 E2 shift & Alarm$ 444 I !Power line down I Check boxes if i Incident Type - dates are the Month Day Year Hr Min Sec Local option 1 same as Alarm ALARM always required C Aid Given or Received* Date. Alarm I 021 24! I 2o07I I19:05:00 ! Shift or Alarms District 1 ❑Mutllal aid received I II ARRIVAL required, unless canceled or did not arrive Platoon 2 ['Automatic aid racy. Their FDID lTh�eirJl ❑ Arrival 1 021 I 241 I 20071119:15:00 I 3 Mutual aid State E+ 3 ❑ given CONTROLLED Optional, Except for wildland fires Special 5tudaesl 4 ❑Automatic aid given _J ❑Controlled 1 021 I 241 1 20071119:15:001 Local Option 5 ®Other aid given Their LAST UNIT CLEARED, required except for wildland fires I N ®None Incident Number Last Unit L�_� I Special Cleared I 021 I 241 I 2007I119:15:00 I Study ID# SttudyaValue F Actions Taken * G1 Resources at G2 Estimated Dollar Losses & Values IllCheck this box and skip this section if an Apparatus or LOSSES: Required for all fires if known. Optional 145 I !Remove hazard Personnel form is used. for non fires. ___J None Primary Action Taken (1) Apparatus Personnel property $I 1 , 1 000J,' 006! 0 ! 1 J Suppression 1 11 JI I Contents $1 1 , 1 0001,1 00©! ❑ Additional Action Taken (2) EMS ! 1 PRE-INCIDENT VALUE: Optional L___J I I Other I 00011 I 00031 Additional Action Taken (3) E"( Property $1 id I 00om cool ❑ Check box if resource counts include aid received resources. t Contens $! Completed Modules - - J , ' cool,! ooJ 0 �jl*Casualties❑None H3 Hazardous Materials Release j Mixed Use Property ['Fire-2 Deaths Injuries N ® one N NN X Not Mixed ❑Structure-3 Fire ! 110 Assembly use ❑Civil Fire Cas.-4 service I 1 ❑Natural Gas: slow leak, no emanation or Havmat action. 20 =Education use ❑Fire Serv. Cas.-5 2 ❑Propane gas: <21 lb. tank (as in home HHo grill) 33 ®Medical use civilian' I 1 1 3 ❑Gasoline: vehicle foal tank❑EMS-6or portable container 40 =Residential use H2 Detector 4 ❑Kerosene: foal burning equipment or portable .forage 51 ®Row of stores ❑E SNdat-7 53 =Enclosed mal]. Required for Confined Fires. 5 ❑Diesel fuel/fuel oil:vehicle fuel tank or portable 58 —Bus. & Residential 0 Wildland Fire-8 10Detector alerted occupants 6 ❑Household solvents: home/office spill, cleanup only 59 --Office use ®Apparatus-9 7 DMotor oil: from engine or portable container 60 _'Industrial use ®Personnel-10 20Detector did not alert them ®Arsonnne 8 ❑Paint: from paint cans totaling c 55 gallon. 63 s Military use ® U❑Unknown 0 0 Other: special Heeosc action. or 65 —Farm use required spill ' SSgal., 0® Other mixed use ... Please complete the HarMat form _ J Property Use* Structures 341❑Clinic,clinic type infirmary 539 ❑Household goods,sales,repairs 342❑Doctor/dentist office 579 ElMotor vehicle/boat sales/repair 131 ['Church, place of worship 3610Prison or jail, not juvenile 571 ❑Gas or service station 161 0 Restaurant cafeteria 162 ❑Ear/Ta 419❑ 1-or 2-family dwelling vrn or nightclub 599 ❑ Business office 213 El Elementary school or kindergarten429❑Multi-family dwelling 615 ElElectric generating plant 439❑Rooming/boarding house 629 Laborator 215 ['High school or junior high ❑ y/science lab 449❑Commercial hotel or motel 700 ❑Manufacturing plant 241 ❑College, adult education 459❑Residential, board and care 819 Livestock 311 ❑Care facility for the aged ❑ /poultry storage(barn) 331 ❑Hospital 464❑Dormitory/barracks 882 ❑Non-residential parking garage 519 0 Food and beverage sales 891 ❑Warehouse Outside 936 ❑Vacant lot 981 0 Construction site 124 ['Playground or park 938 ❑Graded/care for plot of land 984 ❑ Industrial plant yard 655 ['Crops or orchard 946 DLake, river, stream 669 ❑Forest (timberland) 951 ['Railroad right of way Lookup and enter a Property Use code only if 8 07 0 Outdoor storage areayou have NOT checked a Property Use box: 960 El Other street 919 ❑Dump or sanitary landfill Property Use 1962 I 9 ❑Open land or field 961 ❑Highway/divided highway 962 ®Residential street/driveway 'Residential street, road or 1 NFIRS-1 Revision 06/03/05 FIRE RESCUE -'---------------------- - 07009 02/24/2007 07-0018382 __ _B Kl Perscn!Entity Involved I Local Option i I I _ I 1 Business name (if applicable) Area Code Phone Number ®Check This Box if I I I same address as Mr.,Ms., Mrs. First Name . incident location. MI Last Name Then skip the three I II II Suffix I duplicate address �� I U lines. Number Prefix Street or Highway II. Street Type Suffix Post Office Box Apt./Suite/Room I_______ I City u I _I-I ____J State Zip Code °. O More people involved? Check this box and attach Supplemental Forms (NFIRS-1S) as necessary Owner 0 Same as person involved? Then check this box and skip I _ The rest of this section. I (_�� Local Option Business name L__ I - (if Applicable) Area (Dde Phone Number I 0 Check this box if i r.,Ms., MI s. First Name I V ( I I same address as MI Last Name i incident location. I I 'It- 1 I Suffix Then skip the three __JI I lliplicate address Number Prefix Street or Highway I LJ Street Type Suffix Post Office Box A It./Suite/Room City 1 UI I-1 J State zip Code -` L Remarks .-. Local Option Respond to a report of a power line down. Arrived on scene and investigated to find a cable tv entrance cable on the road. Removed from the road. 1 1 i 1 1 { L Authorization - a=-s�� -- , 1FRESHWATER,M I ' Freshwater, Marty Officer in charge ID Si ature I ILT I 1304 II 02 ' 12411 2007.1 Sn Position or rank Assignment Month Day Year. Check Box if® I FRESHWATER,M I 'Freshwater, Marty 'LT same I ' 1304 ' 1 021 I 241 I 2007 as charger Member making report ID Signature Position or rank I( in charge. Assignment Month Day Year FIRE RESCUE 07005 02/24/2007 07-0018382 I A MM DD yyyy DDelet107009 I IA I 02 I 1 241 ' 2007 1 13 I 1 07-0018386 000 Change NFIRS -1 FDID * State* Incident Date * I I ❑Change Station Incident Number Basic * Exposure ❑No Activity BLocation* uI ux In.y Seebcbxt ioinu B..v Aueecer nae Lnoo cauo.ne n peu f1Cant ionn .ueed on 1py uor uwW'u ldul.a nn f7.%usla„u, Census Tract 0016 I ®Street address ( . ]-100 2261 I 1 1.xothe it,/ ❑Intersection Number/Milepost Prefix1 IAVEI 1 ❑In front of Street or Highway Street Type Suffix ❑Rear of 1 1 Lwaterloo 1 lIA 1 150703 Apt:./Suite/Room City - ❑Adjacent to I State Zip Code ❑Directions Cross street or directions, as applicable I ISecondary Address of `_>6 c Incident Type * Midnight is 0000 Date & Times E2 Shift & Alarmr 1444 I (Power line down I Checkboxes if Incident Type dates are the Month Day Year Hr Min Sec Local Option I same as Alarm ALARM always required D Aid Given or Received* Date. Alarm * 1 021 1 241 1 2007.1118:49:00 1 ICJ Shift o I O11 13 or Alarms District 1 ❑Mutual aid received ARRIVAL required, Platoon 1 C unless canceled or did not arrive 2 ®Automatic aid recv. Their FDID ITheirl ® Arrival I 021 I 241 1 200711.19;03:®O I 3 Mutual aid State E3 ❑ given CONTROLLED Optional, Except for wildland fires Special Studies)4 ❑Automatic aid given [ 1Controlled 1 021 I 241 1 20071119:10:00 I Local Option 5 ['Other aid given Their LAST UNIT CLEARED, re Incident Number required except for wildland fires N ®None ® Last Unit Special Cleared 1 021 1 241 1 20071119:17:00 I Study IDS StudyaValue F Actions Taken * Gl Resources * G2 Estimated Dollar Losses & Values ® Check this box and skip this section if an Apparatus or LOSSES: Required for all fires if known. Optional 186 I (Investigate Personnel form is used, for non fires. None Primary Action Taken (1) Apparatus Personnel property $1 1 , 1 0001,1 00pi 0 I I I Suppression ' Contents $1 l a l 0001,1 0001 Additional Action Taken (2) I EMS I I I PRE-INCIDENT VALUE: Optional I I I _l Other 1 00011 1 00031 Property $1 1 , 1 0001,I 00 Additional Action Taken (3) J 0 F-1 Check box if resource counts L-J include aid received resources. Contents $1 1 , 1 0001,1 0001 0 Completed Modules �l,aCasualties❑None �3 E-iNone NN X Not Mixed Hazardous Materials Release 2 Mixed Use Property ❑Fire-2 Deaths Injuries N Structure-3 Fire I 11 10 Assembly use I 1 ❑Natural Gas: slow leak, no evauation or HaNMat actions ❑Civil Fire Cas.-4 Service 20 ®Education use 2 []Propane gas: c21 lb. tank (as in home HBO grill) ❑Fire Serv. Cas.-5 11 33 Medical use Civilian' I 3 ❑Gasoline: vehicle fuel tank ❑EMS-6 or portable container 40 ®Residential use H2 Detector 4 ❑Kerosene: fuel burning equipment or portable storage 51 Row of stores ❑E SMat-7 53 @ Enclosed mal]. Required for Confined Fires. 5 ❑Diesel fuel/fuel oil:vehicle fuel tank or portable 58 Bus. & Residential ❑Wildland Fire-8 1❑Detector alerted occupants 6 [}Household solvents: home/office spill, cleanup 1 ®Apparatus-9 p only 59 Office use 7 ❑Motor oil: from engine or portable container 60 Industrial use ®Personnel-10 20Detector did not alert them 8 Paint: from 63 'Military use ❑Arson-11 paint cane totaling c 55 gallons U❑unknown 0 0 Other: special HarMat actions required or spill > 55ga1., 65 ®Farme usem Please complete the Ha2Mat form 0® Other mixed use a' 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 3 61❑Prison or jail, not juvenile 57 1 ❑Gas or service station 161 ❑Restaurant or cafeteria 4190 1-or 2-family dwelling 599 ❑ Business office 162 ❑Bar/Tavern or nightclub 429❑Multi-family dwelling 615 Electric generating 213 ❑Elementary school or kindergarten plant 43 9❑Rooming/boarding house 629 Laborator 215 ❑High school or junior high 449❑ ❑ y/science lab Conunercial hotel or motel 700 0 Manufacturing plant 241 ['College, adult education 459❑Residential, board and care 8 19 ❑Livestock/poultry storage(barn) 311 ['Care facility for the aged 33 1 ❑Hospital 464❑Dormitory/barracks 882 Non-residential 519❑Food and beverage sales ❑ parking garage Outside 891 ❑Warehouse 936 0 Vacant lot 981 El Construction site 124 ❑Playground or park 938 ❑Graded/care for plot of land 984 0 Industrial plant and 655 ❑Crops or orchard Y 946 ❑Lake, river, stream 669 ❑Forest (timberland) Lookup and enter a Property Use code only if 951 ❑Railroad right of waypert 807 D Outdoor storage area 960 0 you have NOT checked a Property Use box: Other street 919 ❑Dump or sanitary landfill Property Use 1962I 961 ❑Highway/divided highway 931 ❑Open land or field 962 ®Residential street/driveway 'Residential street, road or 1 NFIRS-1 Revision 06/03/05 FIRE RESCUE a -- 07009 02/24/2007 07-0018386 __ K1 Person/ :ntity Involved I I I I - I I-I Local Option Business name (if applicable) Area Code Phone Number ❑Check This Box if I I L_ I I I I I I_J same address as Mr.,Ms., Mrs. First Name MI Last Name Suffix incident location. Then skip the three I I I L_1 duplicate address Number lines. Prefix Street or Highway Street Type Suffix I I Post Office Box I Apt./Suite/RO� (City L_I I I-I State Zip Code []More people involved? Check this box and attach Supplemental Forms (NFIRS-1S) as necesary K2 Owner 0 Same as person involved? Then check this box and skip I I eI _ I I-I I The rest of this section. Local Option Business name (if Applicable) Area Co:e Phone Number I I I I L_.I I ____ J I I OCheck this box if Mr.,Ms., Mrs. First Name MI Last Name Suffix same address as incident location. I I I_J I I I I I U Then skip the three � duplicate address Number Prefix Street or Highway lines. ( Street Type Suffix Post Office Box I It./Suite/Ro I I ity L _J I I-I I State zip Code Wiz.._..._..._._....: L Remarks Local Option 303 called to 226 Kothe for report of a line down from the ice-storm. Upon arrival, we find that the weather head had been pulled from the house. Not an immediate threat. Mid-America was notified. 10-8 @ 19:17 Lt J Ruehs y( t I L Authorization _ _ �.__ 1RUEHS,J I IRuehs, Jeff I ILT I I 303 I I 021 124I I 20071' Position or rank Assignment Month Day Year Officer in charge ID Signature Check Box if® IRUEHS,J I IRuehs, Jeff I ILT I I 303 I I 02I 124I I 2007II same as Officer Member making report ID Signature Position or rank Assignment Month Day Year in charge. FIRE RESCUE 07009 02/24/2007 07-0018386 . A MM DD YYYY 07009 )IA1 02 I24 2007 4 ❑ U L___ J I07-0018388 Delete FDID * State* Incident Date I 000) NFIRS -1 * Station Incident Number - - 9@Exposure h Basic B Location ge *, _ _ ❑No Activity Module In Section B Al" ternative Location s peci fication'. Use only for Wi ldl nd fires. 1 Census Tract 0 015[]Street address f 02 ®Intersection IL�JI L__J Black Hawk ��� Number/Milepost prefix �' DIn front of street or Highway I I ❑Rear of Le� Laterl®O street Type suffix �Adjaeent to APt /Suite/Room city :Lai 50703 ) State Zip Code ❑Directions N"nt. ::n::::I::e: t ions Ras applicable c Incident �+] Date & Times Midnight is 0000 Type * 4L 44 j )power line down E2 Shift ScAlarm Check boxes if Incident Type dates are the Month Day Year Hr Min Sec Local Option same as Alarm ALARM always required D Aid Given or Received* . 0 Alarm * 2 ) 241 2007 18:55:00 of � Date 1 Mutual aid received Shift or Alarms District �� I ARRIVAL required, unless canceled or did not arrive Platoon 2 ['Automatic did rECV. Their FDID Their ❑ Arrival * 02 24 2007 18:59:00 -® 3 ❑Mutual aid given State �3 CONTROLLED Optional, Except for wildland fires 4 ®Automatic aid given Special esl 5 MI"�other aid ❑Controlled 02I 24I 2007 19:04:00 Local Option flgiven Their LAST UNIT CLEARED, required except for wildland fires N ®None Incident Number Last Unit ' . ❑ Cleared ©2 I 24) I 2007) 19:04:00 StudyaIDp 1 ,._...�. �.m Special F. Actions Taken * "" Study value Gl Resources * G2 Estimated Dollar ® Check this box and skip this Losses & Vallles, 45 )Remove hazard section if an Apparatus or LOSSES: Required for all fires if known. Optional Personnel form is used. for non fires. Primary Action Taken (1) Apparatus Personnel None: Property Suppression 1-_ I $� 0 000 000 ❑ L Contents $� I 000 , 000J Additional Action Taken (2) EMS ._J ❑ PRE-INCIDENT VALUE: Optional Other 0001 0003 Additional Action Taken (3) Property $I 0®0 0®0 ❑ Check box if resource counts include aid received resources. Contents Completed Modules 1 Casualties[]None3 Hazardous Materials Release I Mixed Use Property ❑Fire-2 Deaths Injuries N None Structure-3 Fire NN Q Not Mixed • 0Civi.l Fire Cas.-4 Service �_. �_ 1 ❑Natural Gas: slow leak, no evauatlee or Hoecoat actions 10 "EducatiAssemblyon use 2 Propane gas: tzl lb. tank (as in home Hs 20 Education use Fire Serv. Cas.-So grill)civilian) 3 ❑Gasoline: 33 Medical use ❑EMS-6 vehicle fuel tank or portable container 40 "Residential use 0 0Ha❑HazMat-7 H2 Detector 4 ❑Kerosene: fuel burning equipment or portable storage 51 "Row of stores zMatnd Fire-8 Requires for Confined Fires. 5 Diesel fuel/fuel oil:vehicle 53 "Enclosed mall. fuel tank or portable 58 "sus.. 1®Detector alerted occupants 6 Household solvents: & Residential ®Apparatu8-9 home/office spill, cleanup only 59 Office use ®Personnel-10 2� 7 ['motor oil: from engine or portable container 60 Industrial use Detector did not alert them �Araon-11 8 ❑Paint: from paint cans totaling63 Military use U0.... e 55g lone - -- as,...,.... o Other: Special HazELat air spill > 55ga1., use actions requires 65 Farm u Property ....-.. .. >.. -.. _ com•1 to the H zreq form 00 Other mixed use Structures 341❑Clinic,clinic type infirmary 539 0 Household goods,sales,repairs 131®Church, place of worship ❑Doctor/dentist office 579 ❑Motor vehicle/boat sales/repair 161 0 Restaurant or cafeteria 3610Prison or jail, not juvenile 571 0 Gas or service station 599 0 Business office 162 Bar/Tavern or nightclub 4190 1-or 2-family dwelling 4290Multi-family dwelling • 213 Elementary school or kindergarten 615Electric 439❑Rooming/boarding house 0 generatingsieneplant 215 ❑High school or junior high 629 ❑Laboratory/science lab 241 ❑College:, adult education 449❑Commercial hotel or motel 700 0 Manufacturing plant 459❑Residential, board and care /poultry 311 ['Care facility for the aged 819 Livestock 331 �Hoapital 4640Dormitory/barracks storage(barn) 519 0 Food and beverage 882 ❑Non-residential parking garage Outside sales 891 warehouse 124 Playground or park 936 ❑Vacant lot 981 Construction site 655 0Cropa or orchard 938 ❑Graded/care for plot of land 984 0 Industrial plant yard 669 ❑Forest (timberland) 946 ❑Lake, river, stream 807 0 Outdoor storage area 951 ❑Railroad right of way Lookup and enter a Property Use code only if 960 0 Other street you have NOT checked a Property Use box: 919 0 Dump or sanitary landfill Property Use 1.962 931 ®Open land or field 961 ®Highway/divided highway 962 ®Residential street/driveway (Residential street road or I ' ® NFIRS-1 Revision 06/03/05 FIRE RESCUE 07009 02/24/2007 07-0018388 ICl Person/Entity Involved I Jj I I I^ Local Option I L__.____J Business name (if applicable) Area Code Phone Number Check This Box if I I I I I I �J Mr..Me., Mrs. First Name MI Last Name Suffix same address as incident location. Then skip the three I ( I L� duplicate address (Number I I I lines. Prefix Street or Highway Street Type Suffix I I I I I I { Post Office Box Apt./Suite/Room City L__J I I-1 I State Zip Code More people involved? Check this box and attach Supplemental Forms (NFIRS-1S) as necessary a n K2 Owner 0 Same as person involved? _.� Then check this box and skip I I I I - I I The rest of this section. Local Option Business name (if Applicable) Area Code Phone Number I I I I I_J I I L_J CICheck this box if Mr.,Ms., Mrs. First Name Same address as MI Last Name Suffix incident location. I I L� I ( I I U Then skip the three duplicate address Number Prefix Street or Highway Street Type Suffix lines. I Post Office Box Apt./Suite/Room I City L___J I _J-I I State Zip Code L Remarks Local Option Respond to a report of a power line down. Arrived on scene and investigated to find a cable tv entrance cable down. Cut and removed from the roadway. . r 1 1 L Authorization "..._ _" IFRESHWATER,M I I Freshwater, Marty I ILT I I304 J I O2I 124I 1 200 j Officer in charge ID Signature Position or rank Assignment Month Day Year Check ® I FRESHWATER,M Box if I 'Freshwater, Marty I ILT I (304 I I 02I 24 ( 2007 same I as Officer Member making report ID Signature. Position or rank Assignment Month nay Year in charge. ---a I FIRE RESCUE 07009 02/24/2007 07-0018388 1 A MM DD yyyy 107009 IA 1 2 ❑Delete NFIRS -1 I state 02 1 1_ 41 I 2007 1 I1 1 107-0018394 1 1 0001* _ * Incident Date * Station Incident Number ❑Change Basic FDID * Exposure ❑No Activity BLocation* LJ Module LInySec[ion BtjuAl Cerna[ri ve Llocation'Specification°luUse o l�Lfojucu°„ ejyu:� Y n y r wiidiandcfir s. Census Tract 1 0 0 0 5 0 0 ®Street address a _ -C ❑Intersection I 5211 1 11Dawson ...g-LL- Number/Milepost Prefix Street or Highway i is 1 1__� ['In front of Street Type Suffix ❑Rear of L I 'Waterloo 1 IIA 1 150703 '- 1 Apt./Suite/Room City ❑Adjacent to 1 State zip Code ❑Directions 1 Cross street or directions, as applicable L 1 Secondary Address = C Incident Type * Date & Times Midnight is o000 I 444 1 El E2 Shift & Alarm (Power line down I Check boxes if Incident Type dates are the Month Day Year Hr Min Sec Local Option same as Alarm ALARM always required D Aid Given or Received* Date. Alarm * 1 021 1 2411 20071119:00:001 la 1 ' 011 it Shift or Alarms District 1 ®Mutual aid received 1 11 ARRIVAL required, unless canceled or did not arrive Platoon 2 DAutomatic aid recv. u [El Arrival1 021 1 241 l 2®©7117 9:10:®® Their FDID Their 3 3 Mutual aid iven State gCONTROLLED Optional, Except for wildland fires ra Special �tdies 4 ❑Automatic aid given I I Q071119:18:®® 1 Local Option Controlled I 021 1 241 1 2 ' 5 ❑Other aid given Their LAST UNIT CLEARED, required except for wildland fires I I 1_ NNone Incident Number Last Unit Special Special Cleared 1 021 1 241 1 20071119:18:00 1 study IOU Study Value F Actions Taken * _ ._._ m., _ _ Gl Resources * G2 Estimated Dollar Losses Values ® Check this box and skip this section if an Apparatus or LOSSES: Required for all fires if known. Optional I for non fires. 145 1 'Remove hazard Personnel form is used. None Primary Action Taken ( Apparatus Personnel Property $1 1 , 1 0001,1 0001 El 1 1 1 Suppression 1 ' 1 1 I Contents $1 I , I 0001,1 QoJ ❑ Additional Action Taken (2) EMS 1 1 1 PRE-INCIDENT VALUE: Optional I 1 1 I Other 1 00011 1 00031 Additional Action Taken (3) Property $1 1 , 1 0001,1_ 000J El ❑ Check box if resurce counts include aid receivedo resources. Contents $1 1 s 1 0001,1 0001 ❑ Completed Modules Hl*Casualties❑None H3 Hazardous Materials Release I Mixed Use Property ❑ CJ Fire-2 Deaths Injuries N None NN X Not Mixed ❑Structure-3 Fire I II 10 Assembly use I 1 ❑Natural Gas: slow leak, no a cation or HatMat actions['Civil Fire Cas.-4 Service "a 2 Q ®Education use 2 ❑Propane gas: <21 lb. tank (as in home BBQ grill) ❑Fire Serv. Cas.-5 33 ®Medical use Civilian' I I I 3 ❑Gasoline: vehicle fuel tank or 40 !Residential use ❑EMS-6 portable container H2 Detector 4 ❑Kerosene: fuel burning equipment or portable storage 51 Row of stores ❑EMS -753 ®Enclosed mall Required for Confined Fires. 5 ❑Diesel fuel/fuel Oil:vehicle fuel tank or portable ❑wildland Fire-8 58 —Bus. & Residential 1❑Detector alerted occupants 6 ❑Household solvents: home/office spill, cleanup 1 ®Apparatus-9 Pony 59 ®Office use 7 ❑Motor oil: from engine or portable container 60 Industrial use ®Personnel-10 20Detector did not alert them 8 Paint: from paint cans totaling< 55 gallons 63 Military use ❑Arson-11 65 Farm use ,_--T U❑Unknown 0 ❑Other: spacial OSeEnt netsone requres or Please complete the HazMat iform spill > sagal., 00 :Other mixed use J Property Use* Structures 34 1❑Clinic,clinic type infirmary 539 ❑Household goods,sales,repairs 342❑Doctor/dentist office 5790 Motor vehicle/boat sales/repair 131 ❑Church, place of worship 3610 Prison or jail, not juvenile 571 ['Gas or service station 161 ❑Restaurant or cafeteria 4 19f 1-or 2-family dwelling 599 ❑ Business office 162 ❑Bar/Tavern or nightclub 2 13 ['Elementary school or kindergarten 429❑Multi-family dwelling 615 Electric❑ generating plantb 4 39❑Rooming/boarding house 629 Laboratory/science 15 ['High school or junior high ❑ lab 449❑Commercial hotel or motel 700 ❑Manufacturing plant 2410 College, adult education 459❑Residential, board and care 819 ❑Livestock/poultry storage(barn) 311 ❑Care facility for the aged 331 ®Hospital 4 64❑Dormitory/barracks 882 ❑Non-residential parking 519❑Food and beverage sales garage Outside 891 ❑warehouse 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 945 ❑Lake, river, stream 669 ❑Forest (timberland) 951 ['Railroad right of way Lookup and enter a Property Use code only if you have NOT checked a Property Use box: 807 ❑Outdoor storage area 960 ❑Other street 919 ❑Dump or sanitary landfill Property Use 1419 1 961 ❑Highway/divided highway 931. ❑Open land or field ® / 1 1 or 2 familydwelling I 962 Residential street driveway — __� _ a NFIRS-1 Revision 06/03/05 FIRE RESCUE - 07009 02/24/2007 07-0018394 . ' Ki Person/Entity Involved I _____m I I I - 1 � �Local Option Business name (if applicable) Area Code Phone Number I 1 -I 11 I I 1 1-_1 ' ❑Check This Box if e same address as Mr.,Ms., Mrs. First Name incident location. ( MI Last Name Suffix Then skip the three I I I I I ( I L.]duplicate address Number dupls. Prefix Street or Highway I Street Type Suffix Post Office Box I Apt./Suite/Ro I City L_I I I-I I State Zip Code ❑More people involved? Check this box and attach Supplemental Forms (NFIRS-1S) as necessary .�, K2 Owner ❑ Same as person involved? Then check this box and skip I ---I I I - The rest of this section. 1_I Local Option Business name (if Applicable) Area Code Phone Number 1 I I 11 I I _--I L__I Check this box if Mr.,Ms., Mrs. First Name MI Last Name same address as Suffix incident location. I I U 1 I Then skip the three 1 I I L� duplicate address Number Prefix Street or Highway lines. Street Type Suffix Post Office Box I Apt./Suite/Room 1 City L_J I I-1 1 . State Zip Code L Remarks Local Option Called for power line down. On arrival found tree branch on an intact residential power line 1 and a cable TV line on the ground. Both lines were in the back yard of the residence. Removed the branch from the power line with a pike pole. Cable TV line was not a hazard. I { I , Authorization _ INADING,L I INading, Larry I 1LT 1301 I I 021 1241 I 20071 Position or rank Assignment Month Day Year Officer in charge ID Signature Check Box if® I NADING,L I I Nading, Larry I I LT 11 301 I I 02I 24 I 20071 same as Officer Member making report ID Signature Position or rank Assignment Month Day Year in charge. FIRE RESCUE 07009 02/24/2007 07-0018394 107009 FDID MM DD YYYY 1 I1 .A * Incident Date 102 I L241 I 2007 I state 15 J I o7-0018396 I ' o001 Change Station Incident Number * Exposure Delete No Activity jpFIRS -1 Basic a intiu..ai� is ya Wau 9^Uu ��ar•'vr�i{�iauu B Location* LJ ModuleIn Section H"Alternative[Location Specification". Use only for Wildland firee,,, CenSUs Tract 10008 1- 00 _ El Street address ` L 4001 I Ilskyview I IRD I L___J t Inersection Number/Milepost Prefix p Street or Highway IDIn front of Street Type I Suffix Rear of L I )Waterloo 1 I 150703 I-L_- 1 L: IIA Apt./Suite/Room City State®Adjacent to Zip Code ❑Directions Cross street or directions, as applicable Secondary Address I ,yfliffilkiil '/ Incident Type * E1 Date & Times Midnight is 0000 E2 Shift & Alarms I444 I [Power line down 1 Check boxes if Month Da Local Option Incident Type dates are the y Yeas Hr Min SeC same as Alarm ALARM always required IC I I oil [5 D Aid Given or Received* Date' Alarm * 1 021 ) 241 I 20071119:16:00 1 Shift or Alarms District Platoon 1 Mutual aid received [ I' ARRIVAL required, unless canceled or did not arrive 2 ['Automatic aid racy. Their FDID Their Arrival * ) 021 ' 241 ( 20071119:27:001 E3 3 Mutual aid given State CONTROLLED Optional, Except for wildland fires Special StudieSl 4 [Automatic aid given L 1 ®Controlled 1 021 1 241 1 20071119:29:00 I Local Option 5 Other aid given Their LAST UNIT CLEARED, required except for wildland fires I I I__ N ®None Incident Number ❑ Last Unit 021 1 241 I 20071119:29:00 1 Special Special Value Cleared y F Actions Taken * Gi Resources * G2 Estimated Dollar Losses &Values '.. ® Check this box and skip this LOSSES: Requiredp section if an Apparatus or for all fires if known. Optional 186 I IInvestigate I Personnel form is used. for non fires. None Primary Action Taken (1) Apparatus Personnel Property $1 1 , 1 0001,1 0001 El I I Suppression 1 I I I Contents $1 I a ( 0001,1 000] 111 Additional Action Taken (2) EMS 1 I ( I PRE-INCIDENT VALUE: Optional 1 1 L .___I Other 1 000111 00031 Additional Action Taken (3) Property '$1 1 , 1 0001,1 000.1 ❑ 1-1 Check box if resource counts include aid received resources. Contents $1 1 , 1 000i s1 0001 Completed Modules Hl*CasualtiesUNoneHazardous Materials Release I H3Mixed Use Property ❑Fire-2 Deaths Injuries N ENone N`N j Not Mixed ['Structure-3 Fire 1 II ) 10 Assembly use 1 Natural Gas: slew leak, n action or HarRat actions Civil Fire Cas.-4 Service no 20 —Education use 2 DPropane gas: <21 lb. tank (as in home 820 grill) 33 —Medical use El Fire Serv. Cas. 5 civilian) I I ' 3 ElGasoline: vehicle fuel tank or portable container 40 Residential use El EMS-6 H2 4 ❑Kerosene: fuel burning equipment or portable storage 51 Row of stores EJ HazMat-7Detector 53 aQ Enclosed mall. l hi Required for Confined Fires. 5 0Diesel fuel/fuel oil:vehicle fuel tank or portable El Wildland Fire-8 58 Bus. & Residential 1ODetector alerted occupants 6 ❑Household solvents: home/office spill, cleanup only 59 Office use Apparatus-9 7 Motor oil: 60 _Industrial use from engine or portable container X Personnel-10 2 Detector did not alert them 5 63 Military use ❑Paint: from paint cans totaling< 55 gallons❑Arson-11 ❑ li 65 Farm use U®tinknown 0 Other: Special HazMat action. required or spill > 55ga1., Please complete the Haeiat form — 00 ��ther mixed use tr Property Use* Structures 341 Q Clinic,clinic type infirmary 539 ❑Household goods,sales,repairs 342®Doctor/dentist office 579 El Motor vehicle/boat sales/repair 131 Q Church, place of worship 3 61❑Prison or jail, not juvenile 571 Gas or service station 161 ®Restaurant or cafeteria 4 19® 1-or 2-family dwelling 599 0 Business office 162 [Par/Tavern or nightclub 42 ®Multi-family dwelling 213 ®Elementary school or kindergarten 615 D Electric generating plant 439❑Rooming/boarding house 629 0 Laboratory/science lab 215 ®High school or junior high 4490 Commercial hotel or motel 241 ®College, adult education 700 �Manufacturing plant ''1 459['Residential, board and care 819 Livestock/poultry storage(barn) 311 [I Care facility for the aged 464®Dormitory/barracks 331 ®Hospital 882 El Non-residential parking garage 5190 Food and beverage sales 891 Warehouse Outside 93 6 ®Vacant lot 981 0 Construction site 124 ®Playground or park 938 ®Graded/care for plot of land 984 0 Industrial plant yard 655 ®Grope or orchard 946 ®Lake, river, stream 669 ®Forest (timberland) 951 Railroad ri ht of wayLookup and enter a Property Use code only if g you have NOT checked a Property Use box: 807 0 Outdoor storage area 960 pg Other street 919 Dump or sanitaryProperty Use 1960 1 landfill 961 ❑Highway/divided highway 931 [Open land or field 962 ❑Residential street/driveway 'Street, Other 1 NFIRS-1 Revision 06/03/05 FIRE RESCUE " 07009 02/24/2007 07-0018:396 IZl Person/Entity Involved I _ _ I I - I I L_________J Local Option Business name (if applicable) Area Code Phone Number �Check This Box if I I I I �J I I t I Mr.,Ms., Mrs. First Name MI Last Name same address as incident location. ' ( I I Suffix Then skip the three i duplicate address Number I ( I I I lines. Prefix Street or Highway 6 I Street Type. Suffix Post Office Box Apt./Suite/Room City L-J I I-I I State Zip Code ❑More people involved? Check this box and attach Supplemental Forms (NFIRS-1S) as necessary A.2 Owner Same as person involved? '-- - — _ -- -- -. Then check this box and skip I The rest of this section. I I I _ _ Local Option Business name (if Applicable) I IL I Area Code Phone Number ❑ Check this box if IMr.,Ms., I Mrs. First Name I LJ I I II same address as MI Last Name incident location. I I I I I I U Suffix Then skip the three L_J duplicate address Number Prefix Street or Highway lines. Street Type Suffix Post Office Box I I I I A pt./Suite/Room City L-___II J-I I State zip Code L Remarks __ € Local Option . Dispatched for report of wire down in the 400 blk. of Skyview. I Arrived to find nothing but the wire from the previous call to Skyview �# 18369) . . No hazard found. 1 ! , i 1 j . , L Authorization �� �� '� . ILILJA,P I ILilja, Pete I IALT I I I I 021 1241 I 2OO7I Position or rank Assignment Month Day Year Officer in charge ID Signature Check Box if® I LILJA, P I ILilja, Pete IALT same I ( 02I 24 I 2O07I as Officer Member making report ID Signature Position or rank Assignment Month Da Year in charge. y FIRE RESCUE 07009 02/24/2007 07-0018396 MM DD YYYY IA 107009 IA Delete 02 11241 I 2007 1 11 1 '07-0018399 1 ' cool NFIRS -1 FDID * State Incident Date Change Basic * Station Incident Number * Exposure Eno Activity o aliPh a ISO a uen� ae pau 'u un ace rva3 u pu Location* B 1Module`Is Section H°Alternative Location'Specification'1 Use only foruWildland e Census Tract 0001 1 �00I ®Street address �.�a� 1 5001 IN I I3rd Intersection Number/Mile ost Prefix I 1 Street I I ) P Street or Highway OIn front of Street Type Suffix 0Rear of 1 1 'waterloo 11IA ) 150703 ( ' ❑Adjacent to Il Apt./suite/Room City State Zip Code ElDirections 1 Cross street or directions, as applicable I Secondary Address I 1 t rye„1 c Incident Type * El Date & Times Midnight is 0000 I 444 E2 Shift & Alarm I 'Power line down Check boxes if Incident Type I dates are the Month Day Year Hr Min Sec Local Option same as Alarm ALARM always required D Aid Given or Received* Date. Alarm * I 021 ) 241 1 20071119:48:00 I IC 1 I 011 Il Shift or Alarms District ARRIVAL required, Platoon 1 Mutual aid received I I1 unless canceled or did not arrive 2 ❑Automatic aid recv. Their FDID Their ® Arrival I 021 I 241 1 20071119:50:00 1 State .C�3 3 ['Mutual aid given i CONTROLLED Optional, Except for wildland fires Special Studiesl 4 ®Automatic aid given Controlled ( 02) I 241 I 2 10071119:57:00I Local Option 5 ®Other aid given Their LAST UNIT CLEARED, required except for wildland fires i 1 I N ®None Incident Number Last Unit 1 021 1 24I ' 20071119:57:00 1 Study IOU Special Cleared y Study Value F Actions Taken * Gl Resources * G2 Estimated Dollar Losses & Values ElCheck this box and skip this section if an Apparatus or LOSSES: Required for all fires if known. Optional 145 1 [Remove hazard I Personnel form is used. for non fires. None Primary Action Taken (1) Apparatus Personnel Property $1 III 0001,1 00.0] El ( I I Suppression I I I I Contents $I I , I 000l,l cool Additional Action Taken (2) EMS PRE-INCIDENT VALUE: Optional I 1 I 1 Other 1 00011 1 00031 Additional Action Taken (3) Property $1 1 , 1 0001,1 0001 0 ® Check box if resource counts include aid received resources. Contents $1 1 , 1 0001,1 0001 ElCompleted Modules 1*CasualtiesDNone H3 Hazardous Materials Release I Mixed Use Property Fire-2 Deaths Injuries N None ITN X Not Mixed Structure-3 Fire i 11 ' 10 Assembly use 1 0Natural Gas: slow leak, no eva ation or HazMat actions Civil Fire Cas.-q Service 20 Education use 2 Propane gas: <zl lb. tank (So in home HSQ grill) 33 ®Medical use Fire Serv. Cas.-5 I I Civilian' I 3 ®Gasoline: vehie le fuel tank o ®EMS-6 H2 z Portable container 40 ®Residential use DHazBiat-7 Detector 4 0 Kerosene: fuel burning equipment or portable storage 51 --Row of stores Required for Confined Fires. 5 ['Diesel fuel/fuel oil:,,e 53 Enclosed mall ®wildland Fire-8 hide foci tank or portable 58 Bus. & Residential I� 'Detector alerted occupants 6 DHOueehold solvents: home/office spill, cleanup only 59 Office use IN Apparatus-9 7 ®Motor oil: from engine or portable container 60 Industrial use ®Personnel-10 2®Detector did not alert them — Arson-11 8 ❑Paint: from paint cans totaling < s5 gallons 63 ®Milit-a a use U[Unknown 0 []Other: Special HazMat actions 65 Farm use Please completerequired or spill > ssgal., 00 m�Other mixed use the HazMat form — J Property Use* Structures 341 0 Clinic,clinic type infirmary 539 0 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 161 0 Restaurant or cafeteria 571 Gas service station 41901-or 2-family dwelling 599 Business office 162 ®Bar/Tavern or nightclub 213 OElemenvery school or kindergarten 429 0 Multi-family dwelling 615 Electric generating plant 439 D Rooming/boarding house 629 0 Laboratory/science lab 215 ®High school or junior high 449❑Commercial hotel or motel 700 0 Manufacturing plant 241 ['College, adult education 459 0 Residential, board and care 819 ®Livestock/poultry storage(barn) 311 OCare facility for the aged 464 0 Dormitory/barrack 331 ®Hospital s $$2 ®Non-residential parking garage 519 0 Food and beverage sales 891 0 Warehouse Outside 936 ['Vacant lot 981 0 Construction site ` 124 0 Playground or park 938 ®Graded/care for plot of land 984 0 Industrial plant yard 655 ®Crops or orchard 946 ®Lake, river, stream 669 0Forest (timberland) 951 ['Railroad right of way Lookup and enter a Property Use code only if you have NOT checked a Property Use box: 807 0 Outdoor storage area 960 D Other street 919 ®Dump or sanitary landfill Property Use 1,963 I 981 ®Highway/divided highway 931 ®Open land or field 962 ®Residential street/driveway 'Street or road in commercial I NFIRS-1 Revision 06/03/05 FIRE RESCUE .___ 07009 02/24/2007 07-0018399 K1 Person/Entity Involved I �i I J _ I L Local Option Business name (if applicable) Area Core Phone Number Check This Box if I I I I I same address as Mr.,Ma., Mrs. First Name MI Last Name Suffix )I skip the three incident location. I I I� I .. I I I ('u Then duplicate address Number lines. Prefix Street or Highway Street Type Suffix I I I I Post Office Box Apt./Suite/Room City II I I-I I State Zip Code ❑More people involved? Check this box and attach Supplemental Forms (NFIRS-1S) as necessary K2 Owner Same as person involved? Then check this box and skip I I I I - I I L��.__�J The rest of this section. Local Option Business name (if Applicable) Area Code Phone Number I I I I I_J I I L-J 0 Check this box if Mr.,Ms., Mrs. First Name MI Last Name same address as Suffix incidenth location. ( I U II I I I I u'' Then skip the three duplicate address Number Prefix Street or Highway Street Type Suffix lines. I I I I I Post Office Box Apt./Suite/Room City I_II I-I State Zip Code L Remarks Local Option Called for power line hanging low in roadway. On arrival found cable wire hanging 10 ft. off the ground across the roadway. 301 cut and removed cable TV wire. . { L Authorization . INADING,L I (Nading, Larry I ILT I 1301 J I 02 ( I24,II 20071 • Officer in charge ID Signature Position or rank Assignment Month Day Year Boxciif© I NADING,L I I Nading, Larry I ILT I 1301 I L 02( 124I I 20071 same Position or rank Assignment Month Day Year as Officer Member making report ID Signature g in charge. FIRE RESCUE 07009 02/24/2007 07-0018399 i A mm DD YYYY ['Delete NFIRS -1 107009 1TA I I 02 1 24 2007 I 16 I 1 07-ools4ol o00 ❑Chan ge State* Incident Date I 1 * Station Incident Number I Basic - - * Exposure „erx-rur� n cv man LINO Activity BLocation* uModule In Section B ^Alternative Location Specification,, Use only for Wildland fires. '""•Census Tract QQQQ 0 Street address I (j- �� 1100I ®Intersection 1 I I_I I �`� I L_ I L�1 Number/Milepost Prefix Street or Highway ❑Tn front of Street Type Suffix ❑Rear of L I 'Waterloo I 'IA 1 150701 J Apt./Suite/Room City .1-L�❑Adjacent to L� State Zip Code uDirectiona Hawkeye Rd. 1/2 mile south of Orange Rd. 1 Cross street or directions, as applicable I Secondary Address I '1,'"( j::it C Incident Type * Date & Times Midnight is o000 I 444 1 El E2 Shift & Alarm 1Power line down I Check boxes if Incident MonthDay Local Option Type dates are the Year Hr Min Sec same as Alarm ALARM always required IC I I oil 11 ID Aid Given or Received* Date. Alarm * I 021 J 241 I 20071119:55:00 1 Shift or Alarms District 1 ®Mutual aid received ARRIVAL required, unless canceled or did not arrive Platoon 2 ❑Automatic aid recv. 1 II 1 IN Arrival * 1 02I 1 241 1 20071120:04:00 1 Their FDID Their3 3 ❑Mutual aid given State CONTROLLED Optional, Except for wildland fires Special Studied 4 ❑Automatic aid given 1 1 ®Controlled 1 021 1 241 1 200 71120:19:00 1 Local Option 5 ❑Other aid given Their LAST UNIT CLEARED, required except for wildland fires I I L. N ®None Incident Number ® Last Unit Cleared 1 021 1 241 1 20071120:19:00 1 Special study vale Y F Actions Taken * (i1 Resources (s2 Estimated Dollar Losses & 'VValues ® Check this box and skip this section if an Apparatus or LOSSES: Required for all fires if known. Optional 186 I llnvestigate I Personnel form is used. for non fires. Apparatus Personnel n None Primary Action Taken (1) Property $1 1 , 1 0001,1 0Q"1 0 Suppression 1 "1 182 1 Notify other agencies.®1 1 1 1 Contents $1 I 1 00Q1°I oopj Additional Action Taken (2) EMI I I I PRE-INCIDENT VALUE: Optional I I L I Other 1 00011 1 00031 Additional Action Taken (3) Property $1 1 . 1 O®OJ,1 00J ❑ ® Check box if resource counts include aid received resources. Contents $1 1 , 1 0001,1 002_1 Completed Modules 7*Casualties❑None H3 Hazardous Materials Release T Mixed Use Property 0Fire-2 Deaths Injuries N In NoneNN X Not Mixed Structure-3 Fire I J110 Assembly use I 1 ❑Natural Gas: slew leak, no evauacion or HasMat actions Civil Fire Cas.-4 Service 20 ®Education use El2 ['Propane gas: <zl lb. tank (as in hems HBO grill) 33 —Medical use Fire Serv. Cas.-5 civilian' I 1 1 3 ❑Gasoline: vehicle feel tank o =portable container 40 ®Residential use ❑EMS-6 ❑HaxMat-7 H2 Detector 4 ❑Kerosene: fuel burning equipment or portable storage 51 ®Row of stores Required for Confined Fires. &5 ®Diesel £uel/fuel oil:�e 53 Enclosed mall ®Wildland Fire-8 hide feel tank er portable 58 II'gus. Residential 1®Detector alerted occupants 6 ❑Household solvents: home/office spill, cleanu o 1 1=1Apparatus-9 p on 59 �Offire use 7 ❑Motor oil: from engine or portable container 60 Industrial use ®Personnel-10 2❑Detector did not alert them $ Paint: from 63 Military useEl Arson-11 paint cane totaling< 55 gallons U❑Unknown 0 0 Other: spatial Uss t estiseeSr65 Farm use required o spill a SSgal., 00 ®Other mixed use Please complete the Has at form _ J Property Use* Structures 341❑Clinic,clinic type infirmary 539 0 Household goods,sales,repairs 342❑Doctor/dentist office 579 0 Motor vehicle/boat sales/repair 131 ❑Church, place of worship 3610Prison or jail, not juvenile 571 ❑Gas or service station 161 D Restaurant or cafeteria 4190 1-or 2-family dwelling 599 ❑ Business office 162 ❑Bar/Tavern or nightclub 429®Multi-family dwelling 213 ®Elementary school or kindergarten 615 0 Electric generating plant 439❑Rooming/boarding house 629 Laborator 215 ®High school or junior high 0 y/science lab 449❑Commercial hotel or motel 700 Cj 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 331 Hospital 882 El Non-residential parking garage 519❑Food and beverage sales 891 ❑Warehouse Outside 936 ❑Vacant lot 981 El Construction site 124 Playground or park 938 ❑Graded/care for plot of land 984 0 Industrial plant yard 655 ❑Crops or orchard 946 ❑Lake, river, stream 669 Forest (timberland) 951 ❑Ra.ilroad right of way Lookup and enter a Property Use code only if 807 ❑Outdoor storage area you have NOT checked a Property Use box: 960 ❑Other street Property Use 1961 I 919 ['Dump or sanitary landfill 961 IC Highway/divided highway 931 ❑Open land or field 962 ®Residential street/driveway 'Highway or divided highway I NFIRS-1 Revision 06/03/05 FIRE RESCUE _ .. 07009 02/24/2007 07-0018401 I{1 Person/Entity Involved I 1 - 1 _ L_Local Option Business name (if applicable) Area Code Phone Number ®Check This ox if I I I I I I I same addressB as Mr.,Ms., Mrs, First Name MI Last Name Suffix incident location. L-J I I 1 I L� Then skip the three dupliuplicate address Number I Prefix Street or Highway Street Type Suffix I I I I I I _ Post Office Box Apt./Suite/Room City III I-1 J State zip Code ❑More people involved? Check this box and attach Supplemental Forms (NFIRS-1S) as necessary ~ f K2 Owner Same as person involved? T� Then check this box and skip I I I I - The rest of this section. Local Option Business name (if Applicable) Area Code Phone Number I I I I II I 1 L___J ❑ Check this box if Mr.,Ms., Mrs. First Name MI Last Name Suffix same address as incidenth location. I _ .� I L1 I I I I L Then skip the three duplicate address Number _ Prefix Street or Highway Street Type Suffix lines. I I I I Post Office Box Apt./Suite/Room City l____I I I-I I State zip Code • L Remarks Local Option • Report of transformer fire. On arrival found 12 to 15 power poles broken off with lines on the ground in the ditch on the East side . Advised dispatch to notify MidAmerica. , a I L Authorization -__- m_. IMOORE,M I 'Moore, Michael I ILT I 1306 1 L 021 Lail 20071 ( Officer in charge ID Signature Position or rank Assignment Month Day Year Check ® I MOORS,M I (Moore, Michael I I LT I 1306 I 1 02I 24 2007I same Position or rank Assignment as Officer Member making report ID SignatureMonth Day Year in charge. FIRE RESCUE 07009 02/24/2007 07-0018401 A . MM DD YYYY ❑Delete NFIRS -1 107009 I IA I 02 I 1241 I 2007 I 15 I 1 07-0018404 I 1 0001 ['Change Basic FDID * State* Incident Date * Station Incident Number * Exposure ®® ❑NO Activity eo ,, '''' "�a¢1L1e Census Tract 10029 I_I O1 r B Location* Module In Section B "Alternative Location Specification". Use only for wildland ?es..` ['Street address I CLIO 1 IE I IShaulis _J IRD I L—J Intersection Number/Milepost Prefix P Street or Highway Street Type Suffix ❑In front of ['Rear of I I 'Waterloo 1 IIA I 150703 I-L.. I Apt./suite/Room City State Zip Code ['Adjacent to ❑Directions Cedar Terrace DR Cross street or directions, as applicable ij Secondary Address Incident Type * Midnight is 0000 El Date & Times E2 Shift & AlarmT I 445 I 'Arcing, shorted electrical I Check boxes if Month DayYear Hr Min Sec Local Option Incident Type - dates are the same as Alarm ALARM always required IC I I oil [5 D Aid Given or Received* Date. Alarm * 1 021 1 241 I 20071119:58:00 Shift or Alarms District Platoon ARRIVAL required, unless canceled or did not arrive 1 ['Mutual aid received IL I Arrival 1 021 1 241 I 20071120:12:001 E3 2 ®Automatic aid recv. Their FDID Their State CONTROLLED Optional, Except for wildland fires Special Studies) 3 ['Mutual aid given 4 ['Automatic aid given L I El Controlled I 021 1 241 1 20071120:30:001 Local Option 5 ❑Other aid given Their LAST UNIT CLEARED, required except for wildland fires I I Le Incident Number Last Unit N ®None ❑ I 021 1 241 I 20071120:39:00 1 study StudyaValue Cleared pi Actions Taken* Gi Resources * G2 Estimated Dollar Losses & Values I Check this box and skip this LOSSES: Required for all fires if known. Optional section if an Apparatus or 86 1 'Investigate I Personnel form is used. for non fires. None Apparatus Personnel Property $1 1 , 1 000j,1 0001 ❑ Primary Action Taken (1) Suppression 1 1 I I Contents000 000 I 11 J $1 I , I I I J ❑ Additional Action Taken (2) EMS I I I I PRE-INCIDENT VALUE: Optional " I I I I Other I 00011 1 00031 Property $I I , I 0001,1 00 J ❑ Additional Action Taken (3) ❑ Check box if resource counts include aid received resources. Contents $I I , I 0001,1 0001 Completed Modules Hi*CaSUaltieSEINone H3 Hazardous Materials Release I Mixed Use Property ❑Fire-2 Deaths Injuries N E None Ydbl X Not Mixed Structure-3 Fire 10 Assembly use I II 1 ❑Natural Gas: slow leak, no evauation or Har at actions ❑Civil Fire Cas.-4 Service 1 I 2 o Education use 2 ❑Propane gas: <21 lb. tank (as in home BBg grill) 33 :Medical use -- ['Fire Serv. Cas.-5 civilian) II I 3 ❑Gasoline: vehicle fuel tank or40 ®Residential use ['EMS-6 ❑ portable container 51 Row of stores H2 Detector 4 Kerosene: fuel burning equipment or portable storage ❑HazMat-7 5 ❑Diesel fuel/fuel oil: 53 Enclosed small ide Required for Confined Fires. ehicle fuel tank or portable 58 —Bus. & Residential ❑Wildland Fire-8 6 ['Household solvents: home/office spill, cleanup only 59 ®Offi.ce use 1❑Detector alerted occupants Apparatus-9 7 ❑Motor oil: 60 ®Industrial use from eagles or portable container ®Personnel-10 2❑Detector did not alert them 8 ['Paint: from63 —Military use paint cans totaling a 55 gallons ❑Arson-11 65 Farm use U❑Unknown 0 ❑Other: Special HaaMat actions required or spill > 55ga1., 00 a�Other mixed use Please complete the Casmat form — L 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 3610 Prison or jail, not juvenile 571 ❑Gas or service station 161 ['Restaurant or cafeteria 4190 1-or 2-famil ❑ Y 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 0Laboratory/science lab 215 ❑High school or junior high 449 ommercal hotel or motel ❑Commercial 700 ❑Manufacturing plant 241 ❑College, adult education 459 Residential, board and care 311 ['Care facility for the aged ❑ 819 ❑Livestock/poultry storage(barn) 33 1 ❑Hospital 464®Dormitory/barracks 882 ['Non-residential parking garage 53.9®Food and beverage sales 891 ❑Warehouse Outside 93facan ®v t lot981 ❑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 669 ['Forest (timberland) 951 Railroad right of wayLookup and enter a Property Use code only if ❑ g you have NOT checked a Property Use box: 807 ['Outdoor storage area 960 IN Other street Property Use 1960 1 919 ['Dump or sanitary landfill 961 ❑Highway/divided highway 931 ❑Open land or field 962 ❑Residential street/driveway 'Street, Other I NFIRS-1 Revision 06/03/05 FIRE RESCUE 07009 02/24/2007 07-0018404 1 Person/Entity Involved I --, I I_Irt� Local Option Business name (if applicable) Area Ccie Phone Number I ❑Check This Box if I I I ( I I I _� I I I same address as Mr.,Ms., Mrs. First Name MI Last Name Suffix incident location. Then skip the three ( _ I I J duplicate address Number I ( � L_ Prefix Street or Highway Street Type Suffix Post Office Box Apt./Suite/Room City I I I I-I I State zip Code ®More people involved? Check this box and attach Supplemental Forms (NFIRS-1S) as necessary ---- -- K2 owner f-1 Same as person involved? L-J Then check this box and skip I I 1_____J - 1 I 1________J The rest of this section. Local Option Business name (if Applicable) Area Coc= Phone Number I I I I II I _L__ l I I ❑ Check this box if Mr.,Ms., Mrs. First Name same address as ML Last Name Suffix incident location. I I I_J I I Then skip the three duplicate address Number Prefix Street or Highway - lines. Street Type Suffix I I 1 I I Post Office Box Apt./Suite/Room City I I J-I 1 State Zip Code L Remarks --� e�---- Local Option Dispatched for utility pole fire. On arrival we notice a 'glowing' portion on utility pol just north of the dispatched intersection. We happen to meet up with Mid American truck who was looking for the problem. No fire. Mid American to handle the call / problem. i Authorization �. ___ s _ F I LILJA,P I I Lilj a, Pete I IALT I I I I 021 124I I 20071 Position or rank Assignment Month Day Year Officer in charge ID Signature Check Box if® I LILJA,P I ILilja, Pete I IALT I I same I I 02I 124I I 200Ii 7 as Officer Member making report ID Signature Position or rank Assignment Month Day Year in charge. FIRE RESCUE 07009 02/24/2007 07-0018404 A MM DD YYYY 107009 I IIA I I 02 1 I 241 I 2007 4 I 107-0018407 I I 0001 ❑Delete NFIRS -l. FDID State* Incident Date ❑Change Basic * Station Incident Number Exposure r ❑No Activity BLocation* L— Modul=_fIn�scction&uLLAlternative�Location�s a 1� 1 1j l,a��. "'"" Lie ",iui ""P11C I064 P <ification "i- only for°wildland tires.a Census Tract 0 0 04 Igil Street address (11:7) J-l®0 I ❑Intersection I 5221 1 I (Evergreen 1 1AVE 1 L____J Number/Milepost Prefix Street or Highway ree ❑In front of Street Type Suffix ❑Rear of L I 'Waterloo I IIA 1150703 (- IApt./Suite/Room City ❑Adjacent to state Zip Code ❑Directions Cross street or directions, as applicable I 1 , Secondary Address .� �' il c Incident Type * El Date & Times Midnight is o000 H2 Shift & Alarms (Power line down I Check boxes if Incident Type dates are the Month Day Year Hr Min Sec Local Option 1 444 I same as Alarm ALARM always required D Aid Given or Received* Date. Alarm * ' 021 24I I 2007I120:05:00 I IC 1 01 14 Shift or Alarms District ARRIVAL re Platoon 1 Mutual aid received required, unless canceled or did not arrive i I 2 ['Automatic aid recv. 0 ❑ Arrival y� I 021 I 241 1 2Q07I120:10:001 Their FDID Their 3 State 3 Mutual aid given CONTROLLED Optional, Except for wildland fires Special Studies 4 ❑Automatic aid given I I ❑Controlled I 021 1 241 I 20071120:20:001 Local Option 5 ❑Other aid given Their LAST UNIT CLEARED, required except for wildland fires L______1 1 N ®None Incident Number Last Unit S0 2I 1 2 4 I 1 2 0 0 71 12 0:2 0:0 0 1 StudyalDS StudyyaValue Clearedl F Actions Taken * Gi Resources * G2 Estimated Dollar Losses & Values ® Check this box and skip this section if an A LOSSES: _ is useus or Required for all fires if known. Optional lab I Ilnvrestigate I Personnel form is used. for non fires. None Primary Action Taken (l) Apparatus Personnel Property $1 id 1 0001,1 0001 ❑ 1 1 1 Suppression 1 1 1 I Contents $1 1 , 1 000_1,1 0001 ❑ Additional Action Taken (2) EMS 1 I I 1 PRE-INCIDENT VALUE: optional I 1 1 I Other 1 00011 I 00031 Additional Action Taken (3) Property $1 1 , 1 0001,1 0001 ❑ Check box if resource counts include aid received resources. Contents $1 I , I 0001,1 000J ❑ Completed Modules H1*Casualties❑None H3 Hazardous Materials Release I Mixed Use Property ❑Fire-2 Deaths Injuries N ENone Nal X Not Mixed ❑Structure-3 Fire I I 10 Assembly use 1 1 ❑Natural Gas: slow leak, n nation or sacalat actions❑Civil Fire Cas.-$ Service 2 Q ®Education use 2 ❑Propane gas: <21 lb. tank (as in home BSQ grill) ❑Fire Serv. Cas.-5 3 3 Medical use Civilian' I I 1 3 ❑Gasoline vehicle foal sank or portable container 40 ®Residential use ❑EMS-6 ❑HazMat-7 H2 Detector 4 ['Kerosene: fuel burning equipment Sr portable storage 51 ®Row of stores Required for Confined Fires. 5 ❑Diesel fuel/fuel oil:yehicle fuel tank oz Portable 53 Enclosed mall. 0 Wildland Fire-8 6 ❑Household solvents: home/office spill, cleanup58 Bus. & Residential lOnetector alerted occupants only 59 aOffice use ®Apparatus-9 7 ['motor oil: from engine or portable container 60 Industrial use Personnel-'10 2❑Detector did not alert them 8 Paint: from 63 Military use 0Arson-11 paint cans totaling< 55 gallons U❑unknown 0 0 Other: special Raznat actionsor 65 Farm use Piesee< required spill > 55ga1., 00 —Other mixed use omplete the HazMat Form _ a' Property Use* Structures 341❑Clinic,clinic type infirmary 539 ❑Household goods,sales,repairs 34 2®Doctor/dentist office 579 ❑Motor vehicle/boat sales/repair 3.31 ❑Church, place of worship 3610 Prison or jail, not juvenile 571 ❑Gas or service station 1.61 ❑Restaurant or cafeteria 41.91M 1-or 2-family dwelling 599 ❑ Business office 162 ❑Bar/Tavern or nightclub 213 ['Elementary school or kindergarten42 9 El Multi-familydwelling 615 0 Electric generating plant 43 9❑Rooming/boarding house 629 Laborato 215 ❑High school or junior high ❑ ry/science lab 449❑Commercial hotel or motel 700 ❑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 331 ❑Hospital 882 ❑Ncn-residential parking garage 519['Food and beverage sales 891 ❑Warehouse Outside 936 ❑Vacant lot 981 ❑ Construction site 124 OPlayground or park 938 ❑Graded/care for plot of land 984 ❑ Industrial plant yard 655 ❑Crops or orchard 946 ❑Lake, river, stream 669 ❑Forest (timberland) 951 ❑Railroad right of wayLookup and enter a property Use code only if 807 ❑Outdoor. storage area you have NOT checked a Property IIse box: 960 0 Other street 919 ❑Dump or sanitary landfill Property Use 1419 1 961 ❑Highway/divided highway 931 ®open land or field ❑ / 962 Residential street driveway 11 or 2 family dwelling I -------- NFIRS-1 Revision 06/03/05 FIRE RESCUE 07009 02/24/2007 07-0018407 K1 Fersol./Elitity Involved I �� ! ��� _ _-_ _.I Local Option Business name (if applicable) Area Code Phone Number Thies x I I I I I I I ___J - L )❑Check same addrsBsoasif Mr.,Ms., Mrs. First Name MI Last Name Suffix incident location. 1 I I I I I ( 1 L� Then skip the three duplicate address Number Prefix Street or Highway Street Type Suffix lines. 1 I I 11 Post Office Box Apt./Suite/Room City I I I I-1 I State zip Code ❑More people involved? Check this box and attach Supplemental Forms (NFIRS-1S) as necessary K2 Owner 0 Same as person involved? Then check this box and skip I 1 1 I - ( 1 I 1 The rest of this section. Local Option Business name (if Applicable) Area Code Phone Number 1I ❑ Check this box if Mr.,Ms., Mrs. First Name MI Last Name Suffix same address as incident location. I I IL__I 11 I ( I L_J Then skip the three duplicate address Number Prefix Street or Highway Street Type Suffix lines. I I 1 I 1 Post Office Box Apt./Suite/Room City III I-1 I State Zip Code L Remarks Local Option Respond to a report of a power line down. Arrived on scene and investigated to find a power entrance cable to the residence down across the alley. Isolate area with street dept. barricades. Notified Mid-American Energy of the situation. I i + i I L Authorization I FRESHWATER,M I 1Freshwater, Marty I ILT I 1304 1 I 021 1241 1 20071 i Officer in charge ID Signature Position or rank Assignment Month Day Year Check Box if® same I FRESHWATER,M ( 'Freshwater, Marty I I LT 1 1304 I I 021 1241 I 20071 as Officer Member making report ID Signature Position or rank Assignment Month Day Year in charge. - FIRE RESCUE 07009 02/24/2007 07-0018407 A 'VIM DD YYY 107009 I I IA I 1 02 1 1 241 1 Y2007] 8 11 000 1 El Delete 'FIRS -1 FDID I 1 1 07-0018441 State* Incident Date Station Incident Number ❑Change $Basic* Exposure * Ei No Activity N I r IMOtt '„iy.c s �J'ff�l'rnativ Location Specification". om-c t yfor Ne-oi oro,-erre _ B Location* LJ Module in Section a "Alternative i.ocatise Specification^. Ore only for wildland fires.''''''' Census Tract I0029 [O1 gjStreet address I } Intersection 3091 I I (Belle (.4 � 1 1ST I l�Number/Milepost Prefix Street or Highway El In front of Street Type Suffix ❑Rear of L I Lwaterloo I LTA__J 150702 I-L_ I ['Adjacent to Apt./Suite/Room City State Zip Code ❑Directions Cross street or directions, as applicable ,t� Secondary Address I .:1 ,=4, C Incident Type * E1 Date & Times Midnight is 0000 E2 Shift & Alarm (Electrical wiring/equipment I Check boxes if Incident Type dates are the Month Day Year Hr Min Sec Local Option 440 1 _ same as Alarm ALARM always required IC I I 011 18 D Aid Given or Received* Date. Alarm * I 021 1 241 I 20071121:48:00 1 Shift or Alarmsa District ARRIVAL re Platoon 1 Mlltllal aid received l� quired, unless canceled or did not arrive 2 ❑Automatic aid recv. Their FDID Their ® Arrival * 1 021 I 24I I 2007I I21:56:0� State F'i 3 3 ❑Mutual aid given CONTROLLED Optional, Except for wildland fires Special Studies) 4 0Automatic aid given L I ®Controlled I 01 I 241 I 20071122:13:00 I Local Option 5 DOther aid given Their LAST UNIT CLEARED, required except for wildland fires I I L. N ®None Incident Number Last: Unit Special 1 021 1 24I 1 20071122:13:00 i Study IDS StudyaValue Cleared F Actions Taken * G1 Resources * G2 Estimated Dollar Losses &Values ® Check this box and skip this section if an Apparatus or LOSSES: Required for all fires if known. Optional I86 I 'Investigate 1 Personnel form is used. for non fires. None Primary Action Taken (1) Apparatus Personnel Property $1 I , 1 0001,1 0001 El Suppression 1 I I I I I Contents $I I o I OOOI,1 00� Additional AcEl Taken (2) I EMS I I I I PRE-INCIDENT VALUE: optional I I I 1 Other 1 00011 1 00031 Additional Action Taken (3) Property $1 I , I 000_1,1 00j ❑ ❑ Check box if resource counts include aid received resources. Contents $1 I I 000j,1 0001 ❑ Completed Modules H1*Casualties None ❑ H3 Hazardous Materials Release I Mixed Use Property ❑Fire-2 Deaths Injuries N nNone ljN g Not Mixed Structure-3 Fire 1 I I 1 1 ❑Natural Gas: 10 Assembly use Service slow leak, no evauatioa or HasHat actions ❑Civil Fire Cas.-4 2 ® 20 Education use Propane gas: <zl lb. tank (es in home WI grill) 33 —.Medical use ❑Fire Serv. Cas.-5 Civilian) � I I 3 ❑Gasoline: vehicle fuel tank or portable container 40 Residential use ❑EMS-6 �p.� JC7.G Detector 4 0 Kerosene: fuel burning equipment or portable storage 51 Row of stores 0HazMat-7 5 ❑Diesel fuel/fuel oil:vhil ece feel tank or 53 ®Enclosed mall Required for Confined Fires. portable 58 —Bus. & Residential ❑wildland Fire-8l�netector alerted occupants 6 ❑Household solvents: home/office spill, cleanup only59 ®Office use ®Apparatus-9 7 ❑Motor oil: from engine or portable container 60 Industrial use ®Personnel-10 2anetector did not alert them 63 Military use 8 ❑Paint: from paint cans totaling< 55 gallons❑Arson-11 65 ®Farm use lJ❑unknown 0 0 Other: Special Ha2Mat actions required or spill a 55ge1., Please complete the HanMat form 00 — ®Other mixed use 3' 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 361E:Prison or jail, not juvenile 571 ❑Gas or service station 161 ❑Restaurant or cafeteria 4191N1-or 2-family dwelling 599 ❑ Business of fice 162 ❑Bar/Tavern or nightclub 429❑Multi-family dwelling 615 0 Electric generating plant 213 ❑Elementary school or kindergarten 439❑Rooming/boarding house 629 0 Laboratory/science lab 215 ®High school or junior high 449❑Commercial hotel or motel 700 0 Manufacturing plant 241 ❑College, adult education 459❑Residential, board and care 819 ❑Livestock/poultry storage(barn) 311 ❑Care facility for the aged 331 ❑Hospital 464❑Do:rmitory/barracks 882 ❑Non-residential parking garage 519❑Food and beverage sales 891 ❑Warehouse Outside 936 ❑Vacant lot 981 0 Construction site 124 Playground or park 938 DGraded/care for plot of land 984 0 Industrial plant yard 655 ❑Grope or orchard 946 ❑Lake, river, stream 669 []Forest (timberland) 951 Railroad right of wayLookup and enter a Property Use code only if 8 07 0 Outdoor storage area ® g you have NOT checked a Property Use box: 960 0 Other street Property Use 1419 1 919 ❑Dump or sanitary landfill 961 ❑Highway/divided highway 931 ❑Open land or field 962 ®Residential street/driveway 11 or 2 family dwelling 1 NFIRS-1 Revision 06/03/05 FIRE RESCUE --^----- 07009 02/24/2007 07-0018441 Person/Entity involved I I I Local Option Business name (if applicable) I _ I I L--.1 Area Code Phone Number I I I I L___J ❑Check This Box if Same address as Mr.,Ms., Mrs. First Name MI Last Name l��J incident location. Suffix • Then skip the three I I I I I duplicate address Number I L� lines. Prefix Street or Highway Street Type Suffix Post Office Box Apt./Suite/Roof L______ i City I I I _1-I I State Zip Code More people involved? Check this box and attach Supplemental Forms (NFIRS-1S) as necessary K2 Owner ❑ Same as person involved? Then check this box and skip I The rest of this section. I - I _I Local Option Business name (if Applicable) Area Ccde Phone Number II I ❑ Check this box if Ifir.,Ms., Is. First Name I —J I I I same address as MI Last Name J Suffix incident location. I I U I Then skip the three I I I L� duplicate address Number Prefix Street or Highway lines. Street Type Suffix I Office Box I Apt./Suite/Room I I City StateL-I I I-I I Zip Code L Remarks �_�__�—a_ `� Local Option Twig on fire in a power line. Mid-American got the line clear. e y! { ) . ( II L Authorization �_ 'FROST,) I ' Frost, John I ILT I I I I 021I 20071 Officer in charge ID Signature Position or rank Assignment Monthth Dayy Year Check Box if® I FROST,J I 'Frost, John I ILT I I I I 021 125I I 20071 same as Officer Member making report ID Signature Position or rank Assignment Month Day Year in charge. • FIRE RESCUE 07009 02/24/2007 07-0018441 1 A MM DD YYYY LiDelete NFIRS -1 107009 I IIA I I 02 I 124I I 2007 I 18 I 107-0018460 I I 000I ❑change Basic FDID * State* Incident Date * Station Incident Number * Exposure * ❑No Activity 0029 _ _._.. BLocation* MI ModuleIn Section B "Alternative Location Specification". Use only for Wi ldland fires. 01 ®Street address qlr I IAVE L—I I 41451 I I North ❑Intersection Number/Milepost Prefix Street or Highway Street Type Suffix ❑In front of L I Iv,aterloo I IIA I 150702 l ❑Rear of Apt./Suite/Room City State zip Code ❑Adjacent to ❑Directions Cross street or directions, as applicable Iy Safi >,•ff f Secondary Address Midnight is 0000 E2 Shift & Alarm! C Incident Type * El Date & Times Check boxes if Hr Min Sec Local Option 444 I power line down I Month Day Year dates are the IC122118 Incident Type same as Alarm ALARM always required Date. Alarm * 102I 241 I 2007I I22:56:00 I shift or Platoon Alarms District D Aid Given or Received* ARRIVAL required, unless canceled or did not arrive 1 ['Mutual aid received [ II I ® Arrival * I 021 I 2411 2007I I23:09:00 E' 3 2 Automatic aid recv. Their FDID Their State CONTROLLED Optional, Except for wildland fires Special Studies' 3 ['Mutual aid given 4 ['Automatic aid given I I ®Controlled I 021 I 2411 20071123:19:001 Local Option 5 ❑Other aid given Their LAST UNIT CLEARED, required except for wildland fires I I Incident Number Last Unit Special Special N ®None - ® Cleared 1 021 I 241 I 2007I I23:19:00 I Study ID# Study Value F Actions Taken* G1 Resources * G2 Estimated Dollar Losses & Values ® Check this box and skip this LOSSES: Required for all fires if known. Optional section if an Apparatus or for non fires. None 186 I (Investigate Personnel form is used. Apparatus Personnel property $I I , I 0001 ,1 0001 ❑ Primary Action Taken (1) Suppression I I I I Contents $I 1 , 1 0001 ,1 0001 ❑ I I I I Additional Action Taken (2) EMS ( I I I PRE-INCIDENT VALUE: Optional I I L_____ I Other I 0001! I 00031 Property $I I , I 0001 ,1 0001 ❑ Additional Action Taken (3) Check box if resource counts ❑ include aid received resources. Contents $I 1 , I 0001,1 0001 ❑ Completed Modules }.ji*Casualties❑None H3 Hazardous Materials Release I Mixed Use Property j ®None NN X Not Mixed 0Fire-2 Deaths In uries N 10 Assembly use ❑Structure-3 Fire I I I I 1 ❑Natural Gas: slaw leak, no evauation or Ha:Mat actions 20 ®Education use Service _Medical use ['Civil Fire Cas. 4 2 ❑Propane gas: <11 lb. tank as in home HMO grill) 33 ❑Fire Serv. Cas.-5 I I I 0 Gasoline: vehicle fuel tank or portable container 40 ®Residential use Civilian' 3 51 Row of stores Kerosene: fuel burning equipment or portable storage ❑EMS-6 Detector 4 g 53 —Enclosed mall 0HazMat-7 H2Required for Confined Fires. 5 ❑Diesel fuel/fuel oil:vehicle fuel tank or portable 58 ®Bus. & Residential ❑Wildland Fire-9 6 ❑Household solvents: home/office spill, cleanup only 59 ®Office use 1❑netector alerted occupants 60 Industrial use ®Apparatus-9 7 ❑Motor oil: from engine or portable container 63 — Military use ®Personne1-10 20Detector did not alert them 8 ❑paint: from paint Dens totaling a 55 gallons 65 ei Farm use ❑Arson-11 U❑Unknown 0 ❑Other: Special HazMat actions required or spill , 55ga1., 00 Other mixed use Please complete the HazMat form 1a 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 3610Prison or jail, not juvenile 571 ['Gas or service station 161 ❑Restaurant or cafeteria ¢ig® 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 4390Rooming/boarding house 629 ❑Laboratory/science lab 215 ❑High school or junior high 449❑Commercial hotel or motel 700 ❑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 1419 I 919 ['Dump or sanitary landfill 961 ❑Highway/divided highway 931 ['Open land or field 962 ❑Residential street/driveway 11 or 2 family dwelling NFIRS-1 Revision 06/03/O5 FIRE RESCUE 07009 02/24/2007 07-0018460 K 1 Person/Entity Involved I I L______I - I _1 I Local Option Business name (if applicable) Area <:Dde Phone Number I ( I ( t-J Check This Box if Same address as Mr.,Ms., Mrs. First Name MI Last Name Suffix incident location.Then skip the three ( I ( I I I I I I duplicate address Number Prefix Street or Highway Street Type Suffix I I I I I 1 Post Office Box Apt./Suite/Room City II I I-I I State Zip Code 1 ❑More people involved? Check this box and attach Supplemental Forms (NFIRS-1S) as necessary 1 K2 owner 11 Same as person involved?Then check this box and skip ( I I I - I I I_____ I� The rest of this section. Local Option Business name (if Applicable) Area Code Phone Number I I I I I I I l I I ❑ Check this box if Mr.,Ms., Mrs. First Name MI Last Name Suffix same address as incidenth location. I I Then skip the three f duplicate address Number Prefix Street or Highway Street Type Suffix lines. Post Office Box Apt./Suite/Room City L___l I I-I State Zip Code L Remarks Local Option Power line down due to ice storm. Service line to the residence was hit by a falling tree limb. Called for Mid-American Energy. • t I . , • jj Authorization i I FROST,J I ' Frost, John I (LT I I ________I 1 021 1251 I_ 200713 Officer in charge ID Signature Position or rank Assignment Month Day Year Check ® I I I I I I I I I I I L I" Box if FROST,J Frost, John LT 02125 2U07 same Month Assignment Position or rank Year as Officer Member making report ID SignatureDay in charge. FIRE RESCUE 07009 02/24/2007 07-0018460 A MM DD YYYY UDelete NFIRS -1 107003 1 YLik_i 1 02 I 1 251 I 2007 I 13 I 1 07-0018498 I 1 0001 ❑change Basic FDID * State* Incident Date * Station Incident Number Exposure�' Ex p * ❑NO Activity u",ee, ,,,, ,..,t ,,.,lrca a „a ,.,,r ateresspe'' ,,,,� .,,7I-37e .e Y,fan,.0 O,, ,„e 'r,s:a„' r.''B Census Tract I0017 r-L2 I Location* Module In Section B "Alternative Location 5 ecification". Ilse onl for Wildland fires. _- ]Street address 1 020731 1 1 ILOGAN t__[:, I pv s I L-___I ❑Intersection Number/Milepost Prefix Street or Highway 9 Y Street Type Suffix ❑In front of ❑Rear of L 1 'WATERLOO 11IA I 150703 I-L___ I Apt./Suite/Room City State Zip Code ❑Adjacent to ❑Directions Cross street or directions, as applicable I I ' � Secondary Address C Incident Type is Midnight is 0000 Yp El Date & Times E2 Shift & AlarmT 1 440 1 'Electrical wiring/equipment 1 Check boxes if Month Day Year Hr Min Sec Local Option dates are the Incident Type same as Alarm ALARM always required IC 1 1 oil I Date. L `3 D Aid Given or Received* Alarm * 1 021 25) 1 20071102:07:58 I Shift or Alarms District Platoon ARRIVAL required, unless canceled or did not arrive 1 ❑Mutual aid received I II I ® Arrival * 1021 1 251 1 20071[02:15:001 E3 2 ❑Automatic aid recv. Their FDID Their State CONTROLLED Optional, Except for wildland fires Special Studied 3 ❑Mutual aid given P ❑ givenI 1 ® I 1 1 1 I I102:17t001 Local Option 4 Automatic aid Controlled 02 25 2007 5 ['Other aid given Their LAST UNIT CLEARED, required except for wildland fires 1 1 L_ Incident Number Last Unit Special Special N ®None - ® 1 021 1 251 1 20071102:25:00 1 Study ID) Study Value Cleared F Actions Taken * G1 Resources * G2 Estimated Dollar Losses & Values Nn Check this box and skip this section if an Apparatus or LOSSES: Required firefor sall fires if known. Optional for non . 186 I 'Investigate I Personnel form is used. NoneApparatus Personnel Property 1 1 , 1 0001,1 0001 ❑ Primary Action Taken (1) Suppression I I I 1 Contents $1 1 , 1 00®1 ,1 0001( I I � Additional Action Taken (2) EMS 1 1 1 1 PRE-INCIDENT VALUE: optional I I I ____.1 Other 1 00011 I 00031 Property $1 I , 1 0001,1 0001 ❑ Additional Action Taken (3) ❑ Check box if resource counts include aid received resources. Contents $1 I , 1 0001,1 0001 11 Completed Modules Fgl*Casualties❑None H3 Hazardous Materials Release I Mixed Use Property ❑Fire-2 Deaths Injuries N ps None NN X Not Mixed ❑Structure-3 Fire I � 1 ( 1 ❑Natural Gas: 10 ®Assembly use elow leak, no evauation or HatMat actions Education use ❑Civil Fire Cas.-4 Service 2 ❑Propane gas: oil lb. tank (as in home ago grill) 33 ®Medical use ❑Fire Serv. Cas.-5 Civilian' 1 1 1 3 ['Gasoline: vehicle fuel tank or portable container 40 —Residential use o ❑EMS-6 51 4 ❑Kerosene: fuel burning equipment or portable storage Row of stores H2 Detector 53 Enclosed mall ❑xazMat-7 Required for Confined Fires. 5 ❑Diesel fuel/fuel oil:vehiele fuel tank or portable 58 —Bus. & Residential Wildland Fire-8 1®netector alerted occupants ❑ r 59 ®Office use 6 Household solvents: home/office spill, cleanup only El Apparatus-9 60 ®Industrial use 7 ❑MotO1" oil: from engine or portable container 63 Military use 0Personnel-10 21:Detector did not alert them 8 ❑paint: from paint cans totaling e 55 gallons 65 ®Farm use ❑Arson-11 Unknownrequired or spill s 55 gal., ❑ 0 ❑Other: Special Harriet actions sa 00 ®Other mixed use Please complete the HaaMat form — J Property Use* Structures 341❑Clinic,clinic type infirmary 539 ❑Household goods,sales,repairs 342❑Doctor/dentist of fice 579 ❑Motor vehicle/boat sales/repair 131 ❑Church, place of worship 36 1❑Prison or jail, not juvenile 571 ❑Gas or service station 161 ['Restaurant or cafeteria 4 19❑ 1-or 2-family dwelling 599 ❑ Business office 162 ❑Bar/Tavern or nightclub 429❑Multi-family dwelling 615 0 Electric generating plant 213 ❑Elementary school or kindergarten 439❑Rooming/boarding house 629 ❑Laboratory/science lab 215 OHigh school or junior high 449❑Commercial hotel or motel 700 ['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 669 ❑Forest (timberland) 951 ❑Railroad ri ht of wa Lookup and enter a Property Use code only if g Y you have NOT checked a Property Use box 807 ['Outdoor storage area 960 ❑Other street Property Use 1965 J 919 ❑Dump or sanitary landfill 961 ❑Highway/divided highway 931 ❑Open land or field 962 ❑Residential street/driveway 'Vehicle parking area I NFIRS-1 Revision 06/03/05 FIRE RESCUE 07009 02/25/2007 07-0018498 K 1 Person/Entity Involved 1 1 1 I - I 1 1 1 Local Option Business name (if applicable) Area Code Phone Number I I I I I I U ❑Check This Box if MI Last Name Suffix Same address as Mr.,Ms., Mrs. First Name incident location. I I i U Then skip the three duplicate address 1Number I Prefix Street or Highway Street Type Suffix lines. I I I I (Post Office Box Apt./Suite/Room City II I I-I I State Zip Code ®More people involved? Check this box and attach Supplemental Forms (NFIRS-1S) as necessary K2 Owner 0 Same as person involved? Then check this box and skip I I I I - I I I ____ J- The rest of this section. Local Option Business name (if Applicable) Area Code Phone Number __ I . 1 I 1 DCheck this box if Mr.,Ms., Mrs. First Name MI Last Name Suffix same address as incident location. I I I I I I I L�J Then skip the three duplicate address Number Prefix Street or Highway Street Type Suffix lines. Post Office Box Apt./Suite/Room City u I .___I-1 > State Zip Code _ - $ L Remarks Local Option 303 called to 2073 Logan for report of a transformer on fire. Upon arrival, PD states a transformer at the rear of the building had fire coming out of the top. None seen now. Advised dispatch to call Mid-America. 10-8 @ 02:25 Lt J Ruehs • • • i L Authorization 1RUEHS,J I 1Ruehs, Jeff I ILT 1 1 303 1 I 021 125I I 200711 Officer in charge ID Signature Position or rank Assignment Month Day Year Boxcif0IRUEHS,J I 1Ruehs, Jeff I ILT 1 1 303 1 1 021 1251 1 20071 same Position or rank Assignment Month Day Year. as Officer Member making report ID Signature in charge. FIRE RESCUE 07009 02/25/2007 07-0018498 A MM DD YYYY ['Delete NFRS -1I07009 I 02I 251 2007 8 I 107-0018509 I I0001 [1]Change Basic FDID * State* Incident Date * Station Incident Number * Exposure ❑No Activity . 1 LocationI LJ Module In Section S�.Alternative LLocationSpecification". Use only for Wildlande Ei red. Census Tract 10002 I—I 0 0 ❑Street address I I I I IH ® t) I IAV EDIntersection Number/Milepost Prefix Street or Highway g y Street. Type Suffix ❑In front of ❑Rear of L I 'Waterloo 1 1IA I 150702 I-I I Apt./Suite/Room City State zip Code ❑Adjacent to ®Directions HENRY CT 1 Cross street or directions, as applicable Secondary Address Incident Midnight is 0000 Type * El Date & Times E2 Shift & Alarms 1440 1 !Electrical wiring/equipment 1 Check boxes if Month Day Year Hr Min Sec Local option dates are the Incident Type same as Alarm ALARM always required IC I I oil 18 D Aid Given or Received* Date. Alarm * 1 021 251 I 20071102:28:34 I Shift or Alarms 'District Platoon ARRIVAL required, unless canceled or did not arrive 1 ❑Mutual aid received I II C] Arrival * I 02I 1 251 I 20071102:36:oo E3 2 ❑Automatic aid recv. Their FDID Their State CONTROLLED Optional, Except for wildland fires Special Studies) 3 ❑Mutual aid given 4 Automatic aid given 1 ,J [ Controlled I 021 I 251 I 20071102:40:00 1 Local Option 5 ❑Other aid given Their LAST UNIT CLEARED, required except for wildland fires I I L Incident Number Last Unit Special Special N ®None ® Cleared 1 021 I 251 I 20071102:40:00 I Study ID# Study Value F. Actions Taken* G1 Resources * G2 Estimated Dollar Losses & Values ® Check this box and skip this LOSSES: Required for all fires if known. Optional section if an Apparatus or for non fires. Personnel form is used. None 1$6 I 11nvestigate I Apparatus Personnel Property $1 1 , 1 0001,1 0001 ❑ Primary Action Taken (1) Suppression I I I II I I Contents $1 J , I 0011,1 0001 El Additional Action Taken (2) EMS I 1 I I PRE-INCIDENT VALUE: optional 1 I I I Other 1 00011 I 00031 ❑ Property $1 I 11 0001,1 000 Additional Action Taken (3) ❑ Check box if resource counts Li aid received resources. Contents $I 1 , 1 0001,1 0001 Completed Modules ra.*Casualties❑None H3 Hazardous Materials Release I Mixed Use Property ❑Fire-2 Deaths Injuries N ENone NN X Not Mixed 10 Assembly use Fire 0Structure-3 I I I I 1 ❑Natural Gas: slow leak, no eveoetion or HazMat actions Service20 ®Education use Civil Fire Cas.-4 2 ❑Propane gas: <21 lb. tank (as in home Hso grill) 33 Medical use ❑Fire Serv. Cas.-5 —Residential I I I 3 ❑Gasoline: vehicle fuel tank or portable container 40 use ❑ 4 ['Kerosene:EMS-6 51 Row of stores fuel burning equipment or portable storage 53 ® Detector Enclosed mall ❑HazMat-7 Required for Confined Fires. 5 ❑Diesel fuel/fuel oil:vehicle fuel tank or portable 58 ®'Bug, & Residential ❑Wildland Fire-8 10neteccor alerted occupants 6 ❑Household solvents: home/office spill, cleanup only 59 Office use ❑Apparatus-9 7 ®Motor oil: from engine or portable container 60 Industrial use 63 Military use $ Personnel.-10 2�neteator did not alert them 8 paint: from 65 ®Farm use ❑ ❑ palm cane totaling< 55 gallons 1:1Arson-11 U❑Unknown 0 ❑Other: Special HazMat actions required or spill > 55ga1., 00 —Other mixed use please complete the HazMat form J Property Use* Structures 341❑Clinic,clinic type infirmary 539 ❑Household goods,sales,repairs 342❑Doctor/dentist office 579 ❑Motor vehicle/boat sales/repair 13 1 ❑Church, place of worship 3610 Prison or jail, not juvenile 5'71 ❑Gas or service station 1610 Restaurant or cafeteria 4190 1-or 2-family dwelling 599 0 Business of fice 162 ❑Bar/Tavern or nightclub 42 9❑Multi-family dwelling 615 ❑Electric generating plant 213 ❑Elementary school or kindergarten 439❑Rooming/boarding house 62 9 ❑Laboratory/science -lab 215 ❑High school or junior high 449❑Commercial hotel or motel 700 ['Manufacturing plant 241 LI College, adult education 4590 Residential, board and care 819 ❑Livestock/poultry storage(barn) 311 ❑Care facility for the aged 464❑Dormito 882 ❑ parking garage Dormitory/barracks Non-residential arkin 331 ❑Hosp:ital 519❑Food and beverage sales 891 0 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 669 Forest (timberland) 951 ❑Railroad right of wayLookup and Toter a Property Use code only if ❑ 9 you have NOT checked a Property Use box: 807 ❑Outdoor storage area 960 ®Other street Property Use 1960 I 919 ❑Dump or sanitary landfill 961. ❑Highway/divided highway 931 ❑open land or field 962 ❑Residential street/driveway (Street, Other NFIRS-1 Revision 06/03/05 FIRE RESCUE 07009 02/25/2007 07-0018509 K i Person/Fntity Involved I I I - I ( L-_ Local Option Business name (if applicable) I I Area Code Phone Number ❑ Check This Box if I I ' I t-I I I L�! same address a5 Mr.,Ms., Mrs. First Name MI Last Name Suffix incidenthI ( `location. I I I I I�J Then skip the three �_J duplicate address Number Prefix Street or Highway Street Type lines. Suffix I I I I I I Post Office Box Apt./Suite/Room City I_ I I I- I I State Zip Code ®More people involved? Check this box and a_tta.ch Supplemental Forms (NFIRS-1S) as necessary K2 Owner 0 Same as person involved? Then check this box and skip I I I I - I I I ____I The rest of this section. Local Option Business name (if Applicable) Area Code Phone Number I I I I I I I I L_._I ❑ Check this box if Mr.,Ms., Mrs. First Name MI Last Name Suffix same address as '' II - incident location. I I L I I I I I LI Then skip the three duplicate address Number Prefix Street or Highway Street Type Suffix lines. I I I I Post Office Box Apt./Suite/Room City IIl I-L I State Zip Code L Remarks Local Option ': Code 1 response to report of power line down. Removed cable line from the street. L Authorization 1FROST,J I ' Frost, John I ILT I I I I 021 I 251 I 20071 Officer in charge ID Signature Position or rank Assignment Month Day Year I Check ® I I I I I I I I I I I�J I J E Box if FROST,J Frost, John LT 02 25 2007 same Position or rank Assignment Month Da Year as Officer Member making report ID Signature 4 Y 1 in charge. FIRE RESCUE 07009 02/25/2007 07-0018509 i A. M DD YYYY ❑Delete NFIRS -1 107009 J IA I 02 1125I I 2007 I 14 I 107-0018510 I 1 0001 ❑change Basic FDID * State* Incident Date * Station Incident Number * Exposure ❑No Activity Location*B Module In Section B "Alternative Location Specification". Use only for Wildla d f es,/-- Census Tract 0004 - 00, ,,, ❑Street address 1, I I I I ' 'Dundee AVM Intersection Number/Milepost Prefix Street or Highway Street Type Suffix ❑In front of. ❑Rear of I I 'WATERLOO 1 IIA I 150703 Apt./Suite/Room City State Zip Code ❑Adjacent to ❑Directions Harwood AVE Cross street or directions, as applicable Secondary Address Incident Type * Midnight is 0000 E l Date & Times E2 Shift & Alarm? 1444 I 'Power line down I Check boxes if Month DayYear Hr Min Sec Local Option Incidentdates are the Type same as Alarm ALARM always required IC I I oil 14 Aid Given or Received* Date. Alarm * I 021 I 251 I 20071102:36:00 I �l l DShift or Alarms District Platoon ARRIVAL required, unless canceled or did not arrive 1 ❑Mutual aid received I II ❑ I ❑ Arrival * I 021 I 251 I 2007I102:41:00 I E3 2 AlltOmatlC aid reCv. Their FDID Their State CONTROLLED Optional, Except for wildland Eires S 3 ❑Mutual aid given p p Special d tudiesl 4 ['Automatic aid given I ❑Controlled I 02I I 2511 20071IO2:46:00 I Local Option 5 ❑Other aid given Their LAST UNIT CLEARED, required except for wildland fires I I Incident Number Last Unitf� N None Special Special ❑ ❑ Cleared I 021 I 251 ' 2007II02:46:00 I study ILA Study Value F Actions Taken * G1 Resources * G2 Estimated Dollar Losses .5 Values MCheck this box and skip this section if an Apparatus or LOSSES: Required for all fires if known.Optional for non fires. 145 I 'Remove hazard Personnel form is used. None Apparatus Personnel Property $I 1 , 1 0(n,I 0001 El Primary Action Taken (1) Suppression I I I I Contents $1 I . I 00©I,' 0001 ❑ I II I Additional Action Taken (2) EMS ' I I I PRE-INCIDENT VALUE: Optional Other I OOOlI I 00031 Property $I I , I 0001 ,1 0001 ❑ Additional Action Taken (3) ❑ Check box if resource counts include aid received resources. Contents $1 I , I 0001 ,1 0001 Completed Modules Hl*Casualties❑None H3 Hazardous Materials Release I Mixed Use Property ❑Fire-2 Deaths Injuries N E None NN Not Mixed Fire 10 Assembly use ❑Structure-3 I I I I 1 ['Natural Gas: slow leak, no evauation or HazMat actions 20 ®Education use ❑ 2 Civil Fire Cas.-4 Service ❑Propane gas: <zl lb. tank gas in Home En grille 33 Medical use ❑Fire Serv. Cas.-5 civilian' I I I 3 ❑Gasoline: vehicle fuel tank or portable container 40 —Residential use ❑EMS-6 4 ❑Kerosene: fuel burningi 51 Row of stores Detector equipment or portable storage ❑HazMat-7 H 53 Enclosed mall Required for Confined Fires. 5 ['Diesel fuel/fuel oil:veRicle fuel rank or portable 58 —Bus. & Residential ❑wildland Fire-8 'Detector alerted occupants 6 ❑Household solvents: home/office spill, cleanup only 59 ®Office use 0 Apparatus-9 7 ❑Motor oil: 60 —Industrial use from engine or portable container Personnel.-10 2❑Detector did not alert them 8 ❑Paint: from paint cane totaling< SS gallons 63 Military use 0Arson-11 jJ Unknown requires orspill > ss l., 65 Farm use ❑ 0 ❑Other: special HazMat actionsga 00 ®Other mixed use .��c ,i Please complete the MazMat form L' Property Use* Structures 341❑Clinic,clinic type infirmary 539 ❑Household goods,sales,repairs 342❑Doctor/dentist office 57 9 ❑Motor vehicle/boat sales/repair 131 ❑Church, place of worship 361 Prison orjail, notjuvenile ❑ 571 ❑ Goa or service station 161 ❑Restaurant or cafeteria 4 19❑ 1-or 2-family dwelling 599 ❑ Business office 162 ❑Bar/Tavern or nightclub 42 9❑Multi-family dwelling C15 ❑ Electric generating plant 213 ❑Elementary school or kindergarten 43 9 Rooming/boarding house 62 9 Laborato❑ ❑ ry/science lab 215 High school or junior high 449❑Commercial hotel or motel 700 ❑Manufacturing plant 24 1 ❑College, adult education 459❑Residential, board and care 819 ❑Livestock/poultry storage(barn) 311 ['Care facility for the aged 4 64❑Dormitory/barracks 882 ❑Non-residential parking garage 331 ❑Hosp:ital 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 669 Forest (timberland) Lookup and enter a Property Use code only if ❑ 951 ❑Railroad right of way you have NOT checked a Property Use box: 807 ❑Outdoor storage area 960 Other street ❑ Property Use 1962 I 919 ❑Dump or sanitary landfill 961 ❑Highway/divided highway 931 ❑Open land or field 962 ®Residential street/driveway 'Residential street, road or NFIRS-1 Revision 06/03/05 FIRE RESCUE 07009 02/25/2007 07-0018510 Ki Person/Entity Involved 1I I I - ' I-L_____ J Local Option Business name (if applicable) Area Code Phone Number I`�'I I ❑Check This Box if IFirst Name I MI ILast Name I LJ Same address as Mr.,Ms., Mrs. Suffix skip the three incident location. l ( u I I I I I i Then duplicate address Number Prefix Street or Highway Street Type lines. Suffix (Post Office Box Apt./Suite/Room i �City � - _ - I Li I I-I I State zip Code _ ®More people involved? Check this box and attach Supplemental Forms (NFIRS-1S) as necessary K2 Owner ❑ Same as person involved? Then check this box and skip I I I I - I ( L____�I I The rest of this section. Local Option Business name (if Applicable) Area Code Phone Number I I I I I I I I I I ❑ Check this box if Mr.,Ms., Mrs. First Name MI Last Name Suffix same address as incidenth location. I I 1vim L-� I I 1 _ J I Then skip the three ( duplicate address Number Prefix Street or Highway Street Type Suffix lines. I I I I I Post Office Box Apt./Suite/Room City I II I-I I State Zip Code ----� -was L Remarks ( Local Option Respond to a report of a power line down. Arrived on scene and investigated to find a cable f tv entrance cable down. Remove from roadway. IE f i P L Authorization I I FRESHWATER,M I ' Freshwater, Marty I ILT I 1304 I I 02 1 1251 1 20071: Officer in charge ID Signature Position or rank Assignment Month Day Year Check © I FRESHWATER,M J 'Freshwater, Marty I ILT 11 304 I I 02' I 251 I 20071 same - Position or rank Ai nment Month Da Year as Officer Member making report ID Signature g Y , in charge. FIRE RESCUE 07009 02/25/2007 07-0018510 I A MM DD YYYY ❑Delete 107009 J IA I 02 I L251 I 2007i 13 I 1 07-0018547 I I 0001 ❑ NFIRS -1 FOlD State Incident Date Change Basic * * Station Incident Number * Exposure ❑No Activity Location* CJ Mod suleLI Section B"Alternative` on'S ca Locatipecifition".LLUse on for BlyjUWi131andefireslauu ri.c Census Tract 10017 1.-- 0 2 Street address I 0130J I I "`- " ! W 1DONALD 1 1ST I IJ ['Intersection Number/Milepost Prefix P Street or Highway Street Type Suffix ['In front of ❑Rear of I J 'WATERLOO 1 IIA 1 150703 1-1 Apt./Suite/Room City State Zip Code ❑Adjacent to ❑Directions Cross street or directions, as applicable /t) )I I Secondary Address ` C Incident Type El Midnight is 0000 Date & Times E2 Shift & Alarms 1440 I 'Electrical wiring/equipment 1 Check boxes if Local Option Month Da Year Hr Min Sec p Incident Type dates are the Y l_CJ I 0 11 11 same as Alarm ALARM always required D Aid Given or Received* Date. Alarm * I 021 1 251 1 20071107:28:57 1 Shift or Alarms District Platoon ARRIVAL required, unless canceled or did not arrive 1 ['Mutual aid received 1 I I 2 ['Automatic aid recv. Their FDID Their ® Arrival * I 021 1 251 ' 20071107:32:00 a3 State CONTROLLED O 3 ®Mutual aid given ptional, Except for wildland fires Special Studie l 4 ❑Automatic aid given 1 1 ®Controlled 1 021 1 251 I 20071107:35:00 1 Local Option 5 ['Other aid given Their LAST UNIT CLEARED, required except for wildland fires ( I L N ®None Incident Number Last Unit Special Special 1 02I 1 251 1 20071107:38:00 I Study IDS Study Value® Cleared F Actions Taken * G1 Resources * G2 Estimated Dollar Losses & Values JCheck this box and skip this LOSSES: Required for all fires if known. Optional section if an Apparatus or 186 1 IInvestigateI Personnel form is used. for non fires. None Apparatus Personnel Property 1 , 1 0001,1 0001 ElPrimary Action Taken (1) $1 Suppression 1 I I I Contents $1 I , I 0001,1 0001 ❑ II I EMS ' II 1 Additional Action Taken (2) PRE-INCIDENT VALUE: optional I I I Other 1 00011 1 00031 ____JII Property $1 id 1 0001,1 0001 Li Additional Action Taken (3) ❑ Check box if resource counts include aid received resources. Contents $1 1 , 1 0001,1 000 ❑ Completed Modules Hl*Casualties❑None H3 Hazardous Materials Release 1 Mixed Use Property ['Fire-2 Deaths Injuries N EI None NN X Not Mixed 10 mi Assembly use ❑ FireStructure-3 Service �J I I 1 ❑Natural Gas: slow leak, no evauaticn or anuses actions 20 —Education use Civil Fir e Cas.-4 2 ['Propane gas: <21 lb. tank (as in home HBO grill) 33 Medical use ❑Fire Serv. Cas.-5 Civilian) I I I 3 ❑Gasoline: vehicle fuel tank or portable container 40 —Residential use ❑EMS-62 4 ❑Kerosene: fuel burning equipment 51 ®Row of stores Detector 4 4u Pment or portable storage 53 Enclosed mall ❑HazMat-7 Required for Confined Fires. 5 ❑Diesel fuel/fuel oil:vehicle fuel tank or portable 58 —Bus. & Residential Wildland Fire-8 1❑Detector alerted occupants 6 ❑Household solvents: home/office spill, cleanup only 59 ®Off-ice use Ni Apparatus-9 7 ['motor oil: from engine or 60 _Industrial use 9portable container ®Personnel-10 20Detector did not alert them 8 ['Paint: from paint cane totaling< 55 gallons 63 ®Military use 65 Farm use ❑Arson-11 u❑unknown ® Other: Special BacHet actions required or spill > 55ga1., ❑ Please complete the xaraeae form 00 ®Other mixed use J Property Use* Structures 341❑Clinic,clinic type infirmary 539 ❑Household goods,sales,repairs 342❑Doctor/dentist office 579 ❑Motor vehicle/boat sales/repair 13 1 ❑Church, place of worship 36 1❑Prison or jail, not juvenile 571 ❑Gas or service station 161 ❑Restaurant or cafeteria 4 19 1-or 2-family ❑ dwelling 599 ❑ Business office 162 ❑Bar/Tavern or nightclub 429❑Multi-family dwelling 6 15 ❑ 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 ['Manufacturing plant 241 ❑College, adult education 4590 Residential, board and care 8 19 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 983. ❑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 669 Forest (timberland) Lookup and enter a Property Use code only if 951 ['Railroad of way you have NOT checked a Property Use box: 807 ❑Outdoor storage area 960 ❑Other street Property Use 1962 _I 919 ODump or sanitary landfill 961 0T3ighway/divided highway I 931 ❑Open land or field 962 ®Residential street/driveway 'Residential street, road or NFIRS-1 Revision 06/03/05 FIRE RESCUE 07009 02/25/2007 07-0018547 K 1 Person/Entity Involved I I I I - I L-_I P Local Option Business name (if applicable) Area Code Phone Number ❑Check This Box if I I I I U I I I same address as Mr.,Ms., Mrs. First Name MI Last Name Suffix incident location. I I u I I I I I I Then skip the three duplicate address Number Prefix Street or Highway Street Type Suffix lines. I I I I I I ; Post Office Box Apt./Suite/Room City II I -I I State zip Code More people involved? Check this box and attach Supplemental Forms (NFIRS-1S) as necessary K2 Owner El Same as person involved? Then check this box and skip I I I I - I I L __®J The rest of this section. Local Option Business name (if Applicable) Area Code Phone Number I I I I I I I II ❑ Check this box if Mr.,Ms., Mrs. First Name MI Last Name Suffix same address as incident location. Then skip the three -� �� �1 j duplicate address Number Prefix Street or Highway J Highway Street Type Suffix lines. I J I I I ___ ^. Post Office Box Apt./Suite/Room City L_ I I I-I J State Zip Code L Remarks ---- _-$ Local Option 303 called to 1300 W Donald for report of tree debris in power line. Upon arrival, we find a very small branch sizzling. 10-8 @ 07:38 Lt J Ruehs s i L Authorization 1RUEHS,J I I Ruehs, Jeff I ILT I I 303 I I 02 I ( 2511 20071 Officer in charge ID Signature Position or rank Assignment Month - Day Year Check I RUEHS,J I I Ruehs, Jeff I ILT I I 303 I I 02I 125I L 2007I same Position or rank Assignment Month Day Year as Officer Member making report ID Signature i in charge. FIRE RESCUE 07009 02/25/2007 07-0018547 I 1 A MM DD yyyy • III Delete 107009 J IA I 02 1 1 251 I 2007J 11 1 1 07-0018570 11 0001 ❑Change NlBasSic 1 FDID * State* Incident Date * Station Incident Number * Exposure * 1-1 No Activity I x 1n _ u.)=e ,y Pow. ..,,mr«,�e.. rams Census Tract 10018 I-L 8 0 l B Location* LJ Module In Seccion B°AlternativeLLocationJSpecification' Use only for Wildland fires, ra c ['Street address ( I I I 'COTTAGE 1 1ST 1 1 E Intersection Number/Milepost Prefix Street or Highway Street Type Suffix ❑In front of ❑Rear of I I 'WATERLOO 1 'IA 1 150703 .1'1 _� 1 Apt./Suite/Room City State Zip Code ❑Adjacent to I MOBILE ST 1 ❑Directions Cross street or directions, as applicable I I ' • r1) Secondary Address Incident Type Midnight is 0000 yP El Date & Times E2 Shift & Alarms 1444 I 'Power line down I Check boxes if Month DayYear Hr Min Sec Local Option dates are the IA I 1 011 11 Incident Type same as Alarm ALARM always required DAid Given or Received Date. * Alarm * I 021 1 251 I 20071109:31:26 1 Shift or Alarms District Platoon ARRIVAL required, unless canceled or did not arrive 1 ❑Mutual aid received I IU❑ ❑ Arrival * I 021 I 251 I 20071109:37:00 1 '3 2 Automatic aid Y2CV. Their FDID Their State CONTROLLED O Special Studies) 3 ❑Mutual aid given Optional, Except P for wildland fires p 4 ❑Automatic aid given I __I ❑Controlled 1 021 1 251 1 2007.1109:40:00 1 Local Option 5 ❑Other aid given Their LAST UNIT CLEARED, required except for wildland fires I- I NNone Incident Number Last Unit Special Special ❑ ❑ Cleared I 021 I 251 I 20071109:40:00 1 study IDq study value $ F Actions Taken * G1 Resources * G2 Estimated Dollar Losses & Values ® Check this box and skip this LOSSES: Required for all fires if known. Optional section if an Apparatus or for non fires. p 145 I 'Remove hazard I Personnel form is used. None Apparatus Personnel property $I 1 , 1 00j,1 0001 ❑ Primary Action Taken (1) Suppression I I I I Contents $1 I , I 0001,1 0001 ❑ 1 I I I Additional Action Taken (2) EMS I I I 1 PRE-INCIDENT VALUE: Optional 1 Other I 00011 I 00031 Property $1 I , I 0001,1 0001 ❑ Additional Action Taken (3) ❑ Check box if resource counts include aid received resources. Contents $1 1 , 1 000j,1 0 0 0J Completed Modules F1,�Casualties❑None H3 Hazardous Materials Release IMixed Use Property ❑Fire-2 Deaths Injuries N El None NN X Not Mixed 10 Assembly use Fire 0Structure-3 I Service II I 1 ❑Natural Gas: slow leak, no evauation or HarMat actions 20 :Education use ery ['Civil Fire Cas.-4 2 ['Propane gas: c21 lb. tank (as in home IMO grill) 33 Medical use ❑Fire Serv. Cas.-5 Civilian' I I I 3 ❑Gasoline: vehicle fuel tank or portable container 40 —Residential use ❑EMS-6 4 ❑Kerosene: fuel burningequipment 1 —Row of stores Detector 4u pment Sror portable ptorage ❑HazMat-7 H2 53 —Enclosed mall Required for Confined Fires. 5 ['Diesel fuel/fuel Oil:vehicle fuel task,or portable 58 —Bus. & Residential ❑Wildland Fire-8 "Detector alerted occupants 6 ['Household solvents: home/office spill, cleanup only 59 —Office use ®Apparatus-9 7 ['Motor oil: 60 Industrial use from engine Sr portable container — ['Personnel.-10 2❑Detector did not alert the 63 —Military use 8 ['paint: from paint cans totaling 4 55 gallons 65 Farm use Arson-11 U❑Unknovm 0 ❑Other: Special HarMat actions required or spill a 55gal., 00 —Other mixed use ®� _ Please complete the HazMat form 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 3 61 Prison orjail, notjuvenile ❑ 571 ❑Gas or service station 161 ❑Restaurant or cafeteria 4190 1-or 2-family dwelling 599 D Business office 162 ❑Bar/:Cavern or nightclub 429❑Multi-family dwelling 615 ❑ Electric generating plant 213 DElementary school or kindergarten 439❑Rooming/boarding house 629 ❑Laboratory/science lab 215 ['High school or junior high 449❑Commercial hotel or motel 7 00 D Manufacturing plant 241 ❑College, adult education 459 Residential, board and care 819 Livestock❑ ❑ /poultry storage(barn) 311 1 ❑Care facility for the aged 464 Dormitory/barracks barracksNon-residential❑ Y/ 882 ❑ 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 669 Forest (timberland) Lookup and enter a Property Use code only if ❑ 951 ❑Railroad right of way you have NOT checked a Property Use box: 807 ❑Outdoor storage area 960 Other street ❑ Property Use 1962 _1 919 ❑Dump or sanitary la:ndfill 961 ❑Highway/divided highway 1 931 ❑Open land or field 962 ®Residential street/driveway 1Residential street, road or NFIRS-1 Revision 06/03/05 FIRE RESCUE 07009 02/25/2007 07-0018570 P Kl Person/Entity Involved I I I - I I L_ Local Option Business name (if applicable) I I Area Code Phone Number ❑Check This Box if I I I I L__J I I U Mr.,Ms., Mrs. First Name MI Last Name Suffix same address as incident location. Then skip the three I I II 1____ II �I I I I IJ duplicate address Number Prefix Street or Highway Street Type Suffix lines. I I I I I I Post Office Box Apt./Suite/Room City II I I-I I State Zip Code ®More people involved? Check this box and attach Supplemental Forms (NFIRS-1S) as necessary K2 Owner Ell Same as person involved? Then check this box and skip I I I I - L___J L_ __I The rest of this section. Local Option Business name (if Applicable) Area Code Phone Number I I I IL_II I I I 0 Check this box if Mr.,Ms., Mrs. First Name MI Last Name Suffix same address as incident location. I I I�J I ____J I I I _._J Then skip the three duplicate address Number Prefix Street or Highway Street Type Suffix lines. I I I I I I Post Office Box Apt./Suite/Room City II I -I I State Zip Code L Remarks Local Option On 02/25/2007 at 09:31:26 dispatched To COTTAGE ST & MOBILE ST /WATERLOO, IA 50703 . The location is a Residential street, road or residential driveway. The incident was determined to be a Power line down. 09:37:00 arrived on scene. The following actions were performed on scene: • Remove hazard. Arrived to find cable wire was laying across the road. It was pulled loose from 741 Cottage. We rolled it up and placed alongside the pole. Units responding were: Unit 301 responded. • • 09:40 : 00 all units back in service. t . L Authorization t, I RENINGER,C I I Reninger, Carl I ILT I I I I 02.I 12511 20071 Officer in charge ID Signature Position or rank Assignment Month Day Year Check ® I I I I I I I J I I I 25 I L_ I, Box if RENINGER,C Reninger, Carl LT02 2007 ; same Position or rank Assignment Month Day Year f as officer Member making report ID Signature in charge. FIRE RESCUE 07009 02/25/2007 07-0018570. MM DD YYYY [I Delete ' NFIRS -1 107009 1 1i1L1 I 021 1 251 1 2007 1 13 I 1 07-0018592 I I 0001 change Basic FDID State Incident Date Station Incident Number * * * Exposure * ❑NO Activity Burt a ,,.t �r l.e suioe y e,n pcforucu d„ ,.,, ireu , ' \Census Tract I0026 I- d4 I -- BLocation* Module InaSectton 8"Alternative`Locationaspeci fication^tuUse only for wildlande£ireajP�d° A-�'®-,° ]Street address to c'-O I 1 531 1E 1 'BIG ROCK I IRD I L_�I ❑Intersection Number/Milepost Prefix Street or Highway Street Type Suffix ❑In front of ❑Rear of L I 'WATERLOO I IIA I 150703 I-L.___] Apt./Suite/Room City State Zip Code ❑Adjacent to ❑Directions Cross street or directions, as applicable tom& a ?' 1 Secondary Address c IncidentType * Midnight is 0000 Shift & Alarms El Date & Times E2 1444 I 'power line down I Check boxes if Month Day Year Hr Min Sec Local Option dates are the Incident Type same as Alarm ALARM always required IA I I 011 L1 n Aid Given or Received* Date. Alarm * I 021 1 251 I 20071'10:59:51 I Shift or l 1 Alarms District Platoon ARRIVAL required, unless canceled or did not arrive 1 ❑Mutual aid received I II 1 Arrival * I 021 1 251 1 20071111:06:00 13 2 ❑Automatic aid recv. Their FDID Their State CONTROLLED Optional, Except for wildland fires Special Studies) 3 ❑Mutual aid given 4 ❑Automatic aid given 1. 1 MControlled 1 021 1 251 1 20071111:08:00 1 Local Option 5 ['Other aid given Their LAST UNIT CLEARED, required except for wildland fires 1 I I Incident Number Last Unit Special Special N ®None - Cleared 1 021 1 2511 20071111:14:00 I Study IDu Study value F. Actions Taken * G1 Resources * G2 Estimated Dollar Losses & Values ® Check this box and skip this LOSSES: Required for all fires if known. Optional section if an Apparatus Or Personnel form is used. for non fires. None 186 i [Investigate Apparatus Personnel Property $1 1 , 1 0001 ,1 00itli ❑ Primary Action Taken (1) Suppression 1 I I I Contents SI 1 , 1 0001,1 00�1 ❑ I II Additional Action Taken (2) EMS 1 1 I I PRE-INCIDENT VALUE: optional l I L___ Other 1 00011 1 00031 Property $1 1 , 1 0001,1 0001 ❑ Additional Action Taken (3) El Check box if resource counts � LJ include aid received resources. Contents $1 1 , 1 0001,1 00 _1 ❑ Completed Modules Hl*CasualtiesLNone H3 Hazardous Materials Release I Mixed Use Property Not ❑Fire-2 Deaths Injuries N E None NN X Ass Mixed 10 Assembly use Structure-3 Fire �_1 1 1 1 Natural Gas: slow leak, no evauacipn pr Ha=Nat actions 20 —Education Use ❑Civil Fire Cas.-4 service 2 ['Propane gas: an lb. tank (as in home 550 grill) 33 ®Medical use ['Fire Serv. Cas.-5 Civilian' I I 1 3 ❑Gasoline: vehicle fuel tank or portable container 40 Residential use ❑EMS-6 4 ❑ 51 —Row of stores Kerosene: fuel burning equipment or portable storage Detector 53 Enclosed mall ❑HazMat-7 Required for Confined Fires. 5 ['Diesel fuel/fuel oil:vehicle fuel tank or portable 58 —Bus. & Residential ❑ Wildland Fire-8 6 ❑Household solvents: home/office spill, cleanup only 59 —Office use ].[]Detector alerted occupants ['Apparatus-9 7 ❑Motor oil: from engine or portable container 60 Industrial use ❑Personnel-10 2❑Detector did not alert them 63 —Military use 8 ❑Paint: from paint cane totaling� 55 gallons 65 —Farm use 0Arson-11 U❑unknown 0 ❑Other: special HarMat actions required or spill > 55ga1., 00 ®Other mixed use Please complete the HacMat form 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 3 61❑Prison or jail, not juvenile 671 ['Gas or service station 161 ❑Restaurant or cafeteria 4 19❑ 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 43 9❑Rooming/boarding house 629 ❑Laboratory/science lab 215 [High school or junior high 449❑Commercial hotel or motel 700 ['Manufacturing plant 241 `]College, adult education 459['Residential, board and care 819 ❑Livestock/poultry storage(barn) 31.1 ❑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 669 ['Forest (timberland) 951 ❑Railroad right of wayLookup and enter a Property Use code only if g you have NOT checked a Property Use box: 807 ['Outdoor storage area 960 IN Other street Property Use 1960 J 919 ['Dump or sanitary landfill 961 ❑Highway/divided highway 931 ❑Open land or field 962 ❑Residential street/driveway 'Street, Other NFIRS-1 Revision 06/03/05 FIRE RESCUE . 07009 02/25/2007 07-0018592 /C1 Person/Entity Involved I I I i - I L____J Local Option Business name (if applicable) Area Code Phone Number JI II I I_____J 0 Check This Box if Mr.,Ms., Mrs. First Name MI Last Name Suffix same address as incident location. I I I__J I I I I �J Then skip the three $ duplicate address Number Prefix Street or Highway Street TypeSuffix lines. I Post Office Box Apt./Suite/Room City _.I I II- L I I State zip Code DMore people involved? Check this box and attach Supplemental Forms (NFIRS-1S)+ as necessary ----- K2 Owner ❑ Same as person involved? iO Then check this box and skip ( ___II - l_L_____«___J I The rest of this section. Local Option Business name (if Applicable) Area Code Phone Number I I I I I I I ___1 I I ❑ Check this box if Mr.,Ms., Mrs. First Name I MI Last Name Suffix same address as I I L ( _i0� I I I I incident location. -1 I Then skip the three Street Type Suffix duplicate address Number Prefix Street or Highway lines. I I I I I -___] Apt./Suite/Room t Post Office Box City L__,__I I . I-I I . State Zip Code L Remarks Local Option Responded for a power line down. On scene found a cable wire was laying in the roadway. Ti was connected to nothing. We coiled it up and left in ditch. . j ) { L Authorization I HARTER,B J 'Harter, Bill I ILT I I I I 02 I 125I I 20071 I, Position or rank Assignment Month Day Year Officer in charge ID Signature Check ® I HARTER,B J 'Harter, Bill I I LT I I I I 021 1251 L _ 20071.1 same Position or rank Assignment Month Day Year as officer Member making report ID Signature in charge. _. FIRE RESCUE 07009 02/25/2007 07-0018592 A MM DD YYYY uDelete NFXRS -1 107009 IIA I I 02 1125E I 2007 I 15 I 107-0018641 I I 000E ®Change Basic FDID * State* Incident Date * Station Incident Number * Exposure * ❑No Activity ant u et f Census Tract BLocation* Module In Section a .Alternative Locatice aspecf icion iuU onlyafvoruwlulana e 10008 1_)1Q Street, address '' I ®Intersection I 206E I I IPOlk I ST LELJ Number/Milepost Prefix Street or Highway Street Type Su ❑In front of _ ID Rear of I I 'Waterloo I [IA j I 50703 I-I I Zip Code Apt./Suite/Room City ❑Adjacent to I 1 I ®Directions ___1Cross street or directions, as applicable I I ,,e, L Itr . Secondary Address Midnight is 0000 Shift & t�larm� C Incident Type * El Date E. Times E2 1 444 I 'Power line down I Check boxes if Month Day Year Hr Min Sec Local Option dates are the Incident Type same as Alarm ALARM always required IA I I 011 i! DAid Given or Received* Date. Alarm * I 021 1 25) I 20071114:49:00 I l L— Shift or Alarms District Platoon ARRIVAL required, unless canceled or did not arrive 1 ®Mutual aid received I ILA al Arrival * I 021 I 251 I 2007E 114:52:00 I E3 2 ['Automatic aid recv. Their FDID Their State CONTROLLED Optional, Except for wildland fires Special Studie$ 3 ❑Mutual aid given ❑ L I 1EControlled I 02I I 251 I 2007E'14:55:00 I Local Option 4 Automatic aid given 5 ®Other aid given Their LAST UNIT CLEARED, required except for wildland fires I I I___ Incident Number Last. Unit Special Special N I�None — al Cleared I 021 I 25I I 2007E I14:55:00 I Study IDif Study Value F Actions Taken * G1 Resources * G2 Estimated Dollar Losses & Values ® Check ction thisif box Aand rat skip this LOSSES: Required for all fires if known. Optional se anApparatus or for non fires. Personnel form is used. None I86 I 'Investigate ff,,II Apparatus Personnel Property $I 1 , 1 000I,I ®®�1 CI Primary Action Taken (1) Suppression I I I I Contents $1 1 , 1 000] I OOdE ❑ I I l Additional Action Taken (2) EMS L_______I I I PRE-INCIDENT VALUE: Optional I Other I 00011 I 0003E Property $I I , I 0001,1 00 ❑ Additional Action Taken (3) Check box if resource counts ❑ include aid received resources. Contents $I I f I 000E;I 00A ❑ Completed Modules1 CasualtiesLNone H3 Hazardous Materials Release I Mixed Use Property NU X Not: Mixed ❑Fire-2 Deaths Injuries N ®None 10 Assembly use Structure-3 Fire I I I I 1 Natural Gas: slow leak, no evauaticn or Ha=Mat actions20 -*Education use Service❑Civil Fire Cas. 4 2 ['Propane gas: <21 lb. tank (as in home sec grill) 33 Medical use _ Fire Serv. Cas.-5 Civilian! I I I 3 ❑Gasoline: vehicle fuel tank or portable container 40 ❑ Residential use 5 1 �Row of stores ❑EMS-6 4 Kerosene fuel burning equipment or portable storage H2 Detector 53 —Enclosed mall ❑HazMat-7 Required for Confined Fires. 5 ❑Diesel fuel/fuel oil:vehicle fuel tank or portable 58 —Bus. & Residential ❑Wildland Fire--8 6 ['Household solvents: home/office spill, cleanup only 59 —Office use 1']Detector alerted occupants 60 —Industrial use ElApparatus-97 ['Motor oil: from engine or portable container 63 —Military use ['Personnel-10 20Detector did not alert them 8 ❑Paint: from paint cane totaling< 55 gallons 65 Farm use ❑Arson-11 Up Unknown 0 ®Other: Special secant actions requited as spill >Ssgal., 00 -Other mixed use Please complete the HacMat form J Property Use* Structures 341❑Clinic,clinic type infirmary 539 ❑Household goods,sales,repairs 342 Doctor/dentist office 57 9 Motor vehicle/boat sales/repair 131❑Church, place of worship 3610 Prison or jail, not juvenile 57 1 ❑Gas or service station 161 ❑Restaurant or cafeteria 419❑ 1-or 2-family dwelling 599 0 Business office 162 ['Bar/Tavern or nightclub 42 9❑Multi-family dwelling 615 ❑Electric generating plant 213 ❑Elementary school or kindergarten 4390 Rooming/boarding house 629 ❑Laboratory/science lab 215 u High school or junior high 4490 Commercial hotel or motel 700 ['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 L931 I 919 ❑Dump or sanitary landfill 961 ['Highway/divided highway 931 ®Open land or field 962 ❑:Residential street/driveway 'Open land or field I NFIRS-1 Revision 06/03/05 FIRE RESCUE 07009 02/25/2007 07-0018641 sR i Persc /Entity Involved Local Option Business name (if applicable) Area Cote Phone Number II 1 1 I I I L__J ®Check addre This ss a Box sif Mr.,Me., Mrs. First Name MI Last Name Suffix same incident location.Then skip the three I I I_ I I I [--_____II� U duplicate address Number Prefix Street or Highway Street lines. 9 y 'Pe Suffix I I I I I I Post Office Box Apt./Suite/Room City I I --]-I I State Zip Code ❑sore people involved? Check this box and attach Supplemental Forms (NFIRS-1S) as necessary K2 Owner n Same as person involved? t_J Then check this box and skip I I I J I - I I- �� The rest of this section. � Local Option Business name (if Applicable) Area Code Phone Number I I I I I __ I I __-1 I I ❑ Check this box if Mr.,Me., Mrs. First Name MI Last Name Suffix same address as I -J I ' incident location. I 1 L 1 1 L--_� u Then skip the three duplicate address Number Prefix Street or Highway Street Type Suffix lines. L_, , I I I I _ _J Post Office Box Apt./Suite/Room City I-I I I-I I State Zip Code I,, Remarks Local Option On 02/25/2007 at 14:49:00 dispatched To 206 Polk ST /Waterloo, IA 50703 . The location is a Open land or field. The incident was determined to be a Power line down. 14:52:00 arrived on scene. The following actions were performed on scene: Investigated for a wire down behind 206 Polk St, found to be a phone wire hanging across the alley, pulled wire towards the house and attached a loop onto the outside faucet to keep it from hanging in the alley. Units responding were: Unit 305 responded. 14 :55:00 all units back in service. L Authorization I SIGLIN,T 1 1 Siglin, Thomas I ILT I I 305 I I 021 1251 I 20071 Officer in charge ID Signature Position or rank Assignment Month Day Year Check ® ( 1 I I [LTI I i t I I J 1_�®_J Box if SIGLIN,T Siglin, Thomas 305 02 25 2007 same Position or rank Assignment Month Day Year as officer Member making report ID Signature j. in charge. i FIRE RESCUE 07009 02/25/2007 07-0018641 i A MM DD yyyy ®Delete NFIRS -1 [07009 1 iA 102 1 1 251 1 2007 I I$ I 1 07-0018659 1 1 000 ❑Change Basic FDID ' * nc en State Incident DateStation Incident Number * Exposure --- ^^ � ElNo Activity ,' t,,,� Aux ,.� ,�a�c a,a,, ,.,.e ouu,� e ,o, Lu„ LuL, en, .b p,un,ucu u„ Luc ni,u,a„u r Census Tract (� , BLocation* LI Module In Section S "Alternative Location Specification'.vUse only for wildland fires. yc'j to 0 0 2 9 I—Il�f--1 Street address t_ ' I 041451 1 1 !NORTH �.. r'" 1 1ILV I L___I ['Intersection Number/Milepost Prefix Street or Highway g y Street Type Suffix ❑In front of ❑Rear of L I 'WATERLOO I 11A 11 50703 I-L__ I Apt./Suite/Room City State zip Code ❑Adjacent to ❑Directions Cross street or directions, as applicable L i )141 7 =14' Secondary Address C IncidentType Midnight is 0000 El Date & Times E2 Shift & Alarms 1 444 1 Power line down 1 Check boxes if Local Option Month Day Year Hr Min Sec dates are the €� Incident Type same as Alarm ALARM always required IA � 1 Olt L Date. Alarm * I 021 1 251 1 20071115:53:00 Aid Given or Received* Shift or Alarms District Platoon ARRIVAL required, unless canceled or did not arrive 1 ['Mutual aid received (U ❑ Arrival * I 02I I 251 I 20071116:03:00 1 ,3 2 ['Automatic aid recv. Their PDID Their1 State CONTROLLED Optional, Except for wildland fires Special Studies) 3 ❑Mutual aid given 4 ['Automatic aid given i ' ®Controlled 1 021 I 251 I 20071116:22:00 1 Local option 5 ['Other aid given Their LAST UNIT CLEARED, required except for wildland fires 1 I L_ Incident Number Last Unit Special Special N None ❑ I 021 I 251 I 20071116:22:00 1 study ID# Study Value Cleared 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. 186 I I investigate I Personnel form is used. None Apparatus Personnel property $1 1 , 1 000i,1 0001 ❑ Primary Action Taken (1) Suppression 1 1 I 1 Contents $1 1 , I (mid I 00 J Ei 184 1 'Refer to proper I Additional Action Taken (2) EMS ' 1 1 I PRE-INCIDENT VALUE: Optional 1 11 1 Other ( 00011 I 00031 Property $1 1 , I 00 01 ,1 0001 111 Additional Action Taken (3) ❑ Check box if resource counts include aid received resources. Contents $1 1 , 1 Q001 ,1 0001 El Completed Modules H1*Casualties❑None H3 Hazardous Materials Release I Mixed Use Property ❑Fire-2 Deaths Injuries N EI None NN X Not Mixed 10 Assembly use J Structure-3 Fire 1 I ' 1 Natural Gas: slow leak, no evauation or xazMat actions 20 Education use ['Civil Fire Cas.-4 service 2 ®Propane gas: <al lb. tank (ea in home sHQ grill) 33 Medical use Gasoline: vehicle fuel tank or ®Residential use ['Fire Serv. Caa.-S 1 ' 1 1 ❑ 4 0 Civilian 3 portable container ❑EMS-6 4 ['Kerosene: fuel burning equipment or portable storage 51 ®Row of stores H2 Detector 53 Enclosed mall ❑HazMat-7 Required for Confined Fires. 5 ['Diesel fuel/fuel oil:venicle fuel tank or portable 58 ®Bus. & Residential Wildland Fire-8 6 ❑Household solvents: home/office spill, cleanup onl 59 "—Office Office use 1 Detector alerted occupants y ❑Apparatus-9 60 "—Industrial use 7 ['motor oil: from engine or portable container — ®Personnel-10 20netector did not alert them 8® ❑Paint: from paint cans totaling< ss gallons 65 Military use ❑Arson-11 tj Unknow 65 Farm use ❑ 0 ❑Other: special Ha:Nat actions required or spill , ssgal., 00 - Other mixed use Please complete the xazMat form s7 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 3 61❑Prison or jail, not juvenile 571 ['Gas or service station 161 ❑Rest:aurant or cafeteria 4 19❑ 1-or 2-family dwelling 599 El 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 ['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 1962 _I 919 ❑Dump or sanitary landfill 961 ❑Highway/divided highway 1 931 ❑Open land or field 962 Residential street/driveway (Residential street, road or NFIRS-1 Revision 06/03/05 FIRE RESCUE 07009 02/25/2007 07-0018659 IC 1 Person/Entity Involved I I I I I 11 _,_ Local Option Business name (if applicable) Area Code Phone Number I I I I I I I I U ElCheck This Box if Mr.,Ms., Mrs. First Name Same address as MI Last Name Suffix skip the three incident location. I I I I I I I I 1_ 1 Then duplicate address Number Prefix Street or Highway Street Type Suffix I I I I Post Office Box Apt./Suite/Room City III I-I State Zip Code IiMore people involved? Check this box and attach Supplemental Forms (NFIRS-1S) as necessary K2 Owner 0 Same as person involved? II Then check this box and skip I I I I - I I II h...___J The rest of this section. Local Option Business name (if Applicable) Area Code Phone Number I I I IIII I L_____I 0 Check this box if Mr.,Ms., Mrs. First Name MI Last Name Suffix same address as incident location. I I I Then skip the three I�..1� duplicate address Number Prefix Street or Highway Street Type Suffix lines. I I I I I _1 Post Office Box Apt./Suite/Room City 1 I I I-I I State Zip Code -L Remarks Local Option On 02/25/2007 at 15:53:00 dispatched To 4145 NORTH AV /WATERLOO, IA 50702. The location is a Residential street, road or residential driveway. The incident was determined to be a Power line down. • 16:03 :00 arrived on scene. Line down across street. The following actions were performed on scene: Investigate, requested mid America to respond. Street Dept. arrived and placed barricade across street. Units responding were: Unit 308 responded. 16:22:00 all units back in service. { V L Authorization ---__�.,._ _ � .�.__._-.�ztl.._____ I HAUGEN,D I I Haugen, David I (LT I I I I 021 125I I 2007I Officer in charge ID Signature Position or rank Assignment Month Day Year BoxChe 0 I HAUGEN,D I IHaugen, David I I LT I I I I 021 25) i 2007� same Position or rank Assignment Month Year as officer Member making report ID SignatureDay in charge. FIRE RESCUE 07009 02/25/2007 07-0018659 1 MM DD YYYY ❑Delete I07009 I IIA I I 02 1 1251 1. 2007 I 13 I 107-001874sNFIRS -1 I i 0001 ❑Change Basic FDID it. State Incident Date Station Incident Number * * Exposure * ❑No Activity n� Census Tract o01'] BLocation* 1 1 Modu1e`InsSection B "Alternative Location Specification". Use only for wildland fires 01 ®Street address '] c, I 1ST I 1__I 1 11201 IN I 'BARCLAY ❑Intersection Number/Milepost Prefix P Street or Highway y Street Type Suffix ❑In front of 9 ❑Rear of I 1 'WATERLOO I !IA 1150703 I-1 _ 1 Apt./Suite/Room City State zip Code "'Adjacent to ❑Directions L - I Cross street or directions, as applicable L i /-` 2) Secondary Address Incident Type xi Midnight is 0000 CyP El Date & Times E2 Shift & AlarmT 1 444 1 (Power line down I Check boxes if Month Day Year Hr Min Sec Local Option dates are the Incident Type same as Alarm ALARM always required IA 1 I 011 1 Alarm * I 1 1 1 I 11 I 1 AidD Given or Received* Date. 02 25 2007 22:43:51 Shift or Alarms District Platoon ARRIVAL required, unless canceled or did not arrive 1 "'Mutual aid received 1 IL____] ® Arrival * 1 021 I 251 i 20071122:49:00 1 n3 2 ❑Automatic aid recv. Their FDID Their State CONTROLLED Optional, Except for wildland fires Special Studies) 3 ❑Mutual aid given 4 ®Automatic aid given 1 I ®Controlled 1 021 1 251 1 20071122:55:00 1 Local Optionp 5 "'Other aid given Their LAST UNIT CLEARED, required except for wildland fires 1 I L Incident Number Last Unit Special Special N ®None ® Cleared 1 021 1 251 1 20071123:08:00 I study IDS Study Value F. Actions Taken * a1 Resources * G2 Estimated Dollar Losses & Values 111 Check this box and skip this section if an Apparatus or LOSSES: Required for all fires if known. Optional for non fires. 140 1 !Hazardous condition, 1 Personnel form is used. None Apparatus Personnel Property $1 1 , 1 0001 ,1 0001 ❑ Primary Action Taken (1) Suppression 1 1 I IContents $1 1 , 1 0001,1 0001 0 I II Additional Action Taken (2) EMS ' 1 1 1 PRE-INCIDENT VALUE: Optional I I I I Other 1 00011 1 00031 Property $I 1 , I 0001,1 0001 0 Additional Action Taken (3) ❑ Check box if resource counts n' include aid received resources. Contents $1 1 , 1 0001,1 00,j Completed Modules Hl*Casualties❑None H3 Hazardous Materials Release 1 Mixed Use Property ❑Fire-2 Deaths Injuries N I None X Not Mixed 10 Assembly use Structure-3 Fire 3.. Natural Gas: slow leak, no evavatise or ea=coat aceiens Service I II I 2 0 ®Education use ❑Civil Fire Cas.-4 2 ['Propane gas: <21 lb. tank (as in home 8e0 grill) 33 Medical use ❑Fire Serv. Cas.-5 Civilian' I I I 3 ['Gasoline: vehicle fuel tank or portable container 40 ®Residential use El EMS-6 4 ❑Kerosene: 51 ®Row of stores H2 Detector feel burning equipment or portable storage 53 Enclosed mall ❑HazMat-7 Required for Confined Fires. 5 ['Diesel fuel/fuel oil: chime fuel tank or portable 58 ®Bus. & Residential ❑Wildland Fire-8 1❑Detector alerted occupants 6 "'Household solvents: home/office spill, cleanup only 59 Office use ❑Apparatus-9 60 ®Industrial use 7 ❑Motor oil: from engine or portable container Personnel-10 20Detector did not alert them ['Paint: paint cane totaling< 55 gallons 65 ®FMar usery use 8 from 0Arson-11 U Unknown65 Farm use 0 ❑Other: Special Ha=Mat actions required or spill > s5gal., 00 —Other mixed use Please complete the Haseat form — J Property Use* Structures 341❑Clinic,clinic type infirmary 539 ❑Household goods,sales,repairs 342❑Doctor/dentist office 579 0 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 4190 1-or 2-family dwelling 599 ❑ Business office 162 ❑Bar/'.Cavern or nightclub 429❑Multi-famil dwelling ❑ Y 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 ❑Manufacturing plant 241 ❑College, adult education 459❑Residential, board and care 819 ❑Livestock/poultry storage(barn) 3 11 ❑Care facility for the aged 464❑Dormitory/barracks 882 ONon-residential parking garage 331 ❑Hospital 519❑Food and beverage sales 891 ❑Warehouse Outside 936 ['vacant lot 981 ❑Construction site 124 "'Playground or park 938 OGraded/care for plot of land 984 ❑ Industrial plant yard 655 "'Crops or orchard 946 ['Lake, river, stream 669 Forest (timberland) Lookup and enter a Property Use code only if ® 951 ❑Railroad right of way you have NOT checked a Property Use box: 807 ❑Outdoor storage area 960 Other street ❑ Property Use L962 J 919 ❑Dump or sanitary landfill 961 ❑Highway/divided highway 931 ❑Open land or field 962 ®Residential street/driveway !Residential street, road or 1 NFIRS-1 Revision 06/03/05 FIRE RESCUE 07009 02/25/2007 07-0018745 IC1 Person/Entity Involved I I I I _ I L--J Local Option Business name (if applicable) Area Code Phone Number ❑Check This Box if Same address as Mr.,Ms., Mrs. First Name MI Last Name Suffix incidenth location. 1 ' ( 1 1 1 Then skip the three duplicate address Number Prefix Street or Highway Street Type Suffix lines. I I I I Post Office Box Apt./Suite/Room City II I I-1 I State Zip Code "'More people involved? Check this box and attach Supplemental Forms (NFIRS-1S) as necessary K2 Owner. El Same as person involved? Then check this box and skip 1 I I I - 1 I L -I The rest of this section. Local Option Business name (if Applicable) Area Code Phone Number I 1 1 I I-I I L_I 0 Check this box if Mr.,Ma., Mrs, First Name MI Last Name Suffix same address as I incident location. ( I Li I ,J I I L_J Then skip the three duplicate address Number Prefix Street or Highway Street Type Suffix lines. 1 I 1 1 1 Post Office Box Apt./Suite/Room City L__J I I-1 .I State Zip Code L Remarks Local Option Responded for a branch on a power line. On scene found a small branch caught in a power line. Contacted Midamerican Energy and had them put it on the list. • i ��..., L Authorization 'HARTER,B I 'Harter, Bill I 'LT I I I I 021 1281 1 20071 Position or rank Assignment Month Day Year Officer in charge ID Signature HOXcif® ' HARTER,B I 'Harter, Bill I ILT J I I I 02I 128I L 20071 same Position or rank Assignment Month Day Year as Officer Member making report ID Signature i in charge. • FIRE RESCUE 07009 02/25/2007 07-0018745 A MM DD YYYY ❑Delete iQFIRS -1 107009 I 1. 1,_1. I 02 1 1 261 1 2007 I 15 1 107-0018765 I I 0001 ❑Change Basic FDID State Incident Date Station Incident Number �r * Exposure * Ill No Activity Census Tract 0008 - IN 00 BLocation* Module In Section B "Alternative Location Specification". Use only For Wildland fires. r, ®Street address 1,2 t` L 2021 1 1 'BLOWERS , 1 [AV I L_____J Intersection Number/Milepost Prefix P Street or Highway Street Type Suffix ❑In front of ['Rear of I I 1WATERLOO I 1IA 1 150703 IL______ Apt./Suite/Room City State zip Code ❑Adjacent to 1 ❑Directions Cross street or directions, as applicable fig �. g. I________ I > 'c) Secondary Address Midnight is 0000 C' Incident Type * El Date E. Times E2 Shift E. Alarm? 1440 1 !Electrical wiring/equipment I Check boxes if Month Day Year Hr Min Sec Local Option t dates are the Incident Type same as Alarm ALARM always required 1 Aid Given or Received* Date. Alarm * I o21 J 261 1 20071100:01:50 1 IA [ Lill �� Shift or Alarms District Platoon ARRIVAL required, unless canceled or did not arrive 1 ['Mutual aid received I IL-1 ® Arrival I 021 1261 ! 20071100:06:00 J ni3 2 ['Automatic aid recv. Their FDID Their State CONTROLLED Optional, Except for wildland fires S eclal Studiasl 3 ..:. ❑Mutual aid given i l ip 4 ['Automatic aid given 1 11EControlled 1 021 1 261 1 20071100:13:001 Local option 5 ['Other aid given Their LAST UNIT CLEARED, required except for wildland fires ( I L_ Incident Number Last Unit Special Special N ®None 1 021 ! 2611 20071100:13:00 1 stony Inn Study value ® Cleared F. Actions Taken * G1 Resources * G2 Estimated Dollar Losses E. Values 1,171 Check this box and skip this U.1 section if an Apparatus or LOSSES: Required for all fires if known. Optional I$6 1 !Investigate 1 Personnel form is used. for non fires. None, Apparatus Personnel property $1 I , I 0 011 ,( 0001 ❑ , Primary Action Taken (1) Suppression 1 1 1 I Contents $I 1 , 1 0001,I 0001 ❑ 11 Additional Action Taken (2) EMS 1 1 1 I PRE-INCIDENT VALUE: Optional I I I 1 Other 1 00011 1 00031 Property $1 1 , 1 00j,1 0001 Additional Action Taken (3) ❑ Check box if resource counts ( ���� include aid received resources. Contents $1 1 , 1 0 Cj,I 0- - Li Completed Modules Hl*Casualties❑None H3 Hazardous Materials Release I Mixed Use Property ❑Fire-2 Deaths Injuries N ®None NN X Not Mixed ❑Structure-3 Fire 1 Natural Gas: slow leak, no evauacion or xa=Mat actions 10 _Assembly use Service I 11 I 2 0 Education use ❑Civil Fire Cas.-4 2 ['Propane gas: <21 lb. tank (as Sc home BBQ grill) 33 ®Medical use ❑Fire Serv. Cas.-5 I 11 ! ❑Gasoline: vehicle fuel tank o 40 —Residential use Civilian 3 r portable container ❑EMS-6 4 ['Kerosene: equipmentportablestorage51 Row of stores H2 fuel burning or Detector53 Enclosed mall 0HazMat-7 5 ['Diesel fuel/fuel oil:vehicle fuel tank or portable 58 ®Bus. & Residential Required for Confined Fires. ❑Wildland Fire-8 6 ['Household solvents: homeioffice spill, cleanup only 59 Office use 1❑Detector alerted occupants ❑g Apparatus-9 60 Industrial use 7 Motor oil: from engine or portable container — ®Personnel.-10 2❑netector did not alert them 8 ['Paint: paint cans totaling< 55 gallons 65 —"Farm Military use from UArson-11 Up Unknownor 65 Farm use ❑ 0 ❑Other: Special Ba=Mat actions required spill > 55ga1., 00 "-"Other mixed use Please c m.lete the CanNot form 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 3 61❑Prison or jail, not juvenile 571 ['Gas or service station 161 ❑Restaurant or cafeteria 4 19® 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 43 9❑Rooming/boarding house 629 ❑Laboratory/science lab 215 1:High school or junior high 449❑Commercial hotel or motel 700 ❑Manufacturing plant 2 4 1 u 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 0Hospital 519❑Food and beverage sales 891 ❑Warehouse Outside 936 ❑Vacant lot 981 ❑Construction site 124 ❑Playground or park 93g Graded/care for plot of land 984 [' Industrial plant yard 655 ®Crops or orchard 946 ❑Lake, river, stream 669 Forest (timberland) Lookup and enter a Property Use code only if ❑ 951 ®Railroad right of way you have NOT checked a Property Use box: 8 07 ElOutdoor storage area 960 ❑other street Property Use 1419 J gig ❑Dump or sanitary landfill 961 ❑Highway/divided highway 931 ❑Open land or field 962 ❑Residential street/driveway Il or 2 family dwelling 1 NFIRS-1 Revision 06/03/05 FIRE RESCUE 07009 02/26/2007 07-0018765 IC i Person/Entity Involved I I I I - I I L_______I Local Option Business name (if applicable) Area Code Phone Number ❑Check This Box if I I I I I I I same address as Mr.,Ms., Mrs. First Name MI Last Name Suffix incident location. Then skip the three I I I I I____J duplicate address Number Prefix Street or Highway Street Type Suffix lines. I I I I I - ®I Post Office Box Apt./Suite/Room City L__J I I-I I State Zip Code qp D More people involved? Check this box and attach Supplemental Forms (NFIRS-1S) as necessary K2 Owner 11 Same as person involved? Then check this box and skip I I L______J - I i L___,_.-. l The rest of this section. Local Option Business name (if Applicable) Area Code Phone Number I I I I I_I I l I I ❑ Check this box if Mr.,Ms., Mrs. First Name MI Last Name Suffix same address as II incident location. I I I '� I I I I L-1 Then skip the three duplicate address Number Prefix Street or Highway Street Type Suffix lines. I I I I I --J Post Office Box Apt./Suite/Room City I I .1-I I State Zip Code L Remarks Local Option On 02/26/2007 at 00:01:50 dispatched To 00202 BLOWERS AV /WATERLOO, IA 50703 . The. location is a 1 or 2 family dwelling. The incident was determined to be an Electrical I wiring/equipment problem, Other. 1 00:06:00 arrived on scene. The following actions were performed on scene: Investigated the residence for a hot odor, found to be coming from the Fax Machine i.n i their office. Disconnected power to machine. Units responding were: Unit 305 responded. 00:13 :00 all units back in service. i i 1 k_L Authorization ISIGLIN,T 1 I Sig.lin, Thomas I ILT I I 305 _1 I 02_1 1261 1 - 20071 Officer in charge ID Signature Position or rank Assignment Month Day Year Check SIGLIN,T Si lin, Thomas LT 305 021 26 2007 Box if® I I ( g I I I I I I 1 I I L I same Position or rank Assignment Month Day Year as Officer Member making report ID Signature I in charge. ) FIRE RESCUE 07009 02/26/2007 07-0018765 A MM DD YYYY ❑Delete N FIRS -1 107009 , IIA 1 I 02 1 1 261 I 2007 I 14 I 07-0018854 I I 0001 Change Basic FDID * State* Incident Date * Station Incident Number * Exposure ❑No Activity Module In Section B "Alternative Location Specification". Use only for Wildland fir_ea!„, Census Tract 0015 1- 0 2 B Location* �� ' Street address /y _� I� I I_I 1 017001 I I1HUh1TINGTON ❑Intersection Number/Milepost Prefix Street Type Suffix Street or Highway ❑In front of IA ®Rear of IBLK I [WATERLOO 1 150702 1 1 _1-I 1 Apt./Suite/Room City State Zip Code ❑Adjacent to L ®Directions i Cross street or directions, as applicable I I it .-3-el' Secondary Address Midnight is 0000 C Incident Type * El Date & Times E2 Shift & Alarm 1 444 1 [Power line down I Check boxes if Month Day Year Hr Min Sec Local Option Type dates are the Incident same as Alarm ALARM always required IR J I 0 11 [4 D Aid Given or Received* Date. Alarm * I 021 1 20 I 20071111:06:10 1 Shift or Alarms District Platoon ARRIVAL required, unless canceled or did not arrive 1 ❑Mutual aid received 11 1 ® Arrival * 1 021 26 1 20071111:1o:0o 1 E3 2 ['Automatic aid recv. Their FDID Their State CONTROLLED Optional, Except for wildland fires Special Studied 3 ['Mutual aid given P P 4 ❑Automatic aid given 1 _1 ®Controlled 1 021 1 261 1 20071111:10:00 1 Local Option 5 ['Other aid given Their LAST UNIT CLEARED, required except for wildland fires I I L_ Incident Number Last Unit Special Special N ®None ® Cleared I 021 I 261 I 20071111:10:00 I Study IDq Study Value F Actions Taken * G1 Resources * G2 Estimated Dollar Losses & Values ® Check this box and skip this LOSSES: Required for all fires if known. Optional section if an Apparatus or for non fires. 145 I [Remove hazard 1 Personnel. form is used. None Apparatus Personnel Property 000 ElPrimary Action Taken (1) $1 1 , I 0001,1 I Suppression 1 1 I I Contents $1 1 , 1 000J,1 0001 ❑ Additional Action Taken (2) EMS 1 1 1 1 PRE-INCIDENT VALUE: Optional I 11 I Other 1 00011 I 00031 Property $i 1 , 1 0001,1 0001 ❑ Additional Action Taken (3) ❑ Check box if resource counts include aid received resources. Contents $1 1 , 1 00ol,I 0001 Completed Modules II1*Casualties1=INone 1I3 Hazardous Materials Release I Mixed Use Property ❑Fire-2 Deaths [IInjuries N ENone Ni X Not Mixed ❑Structure-3 Fire I J 1 I 1 ❑Natural Gas: n eva 10 ®Assembly use slew leak, n uatinn or HazMat actions 20 Education use ❑ 2 Civil Fire Cas.-4 Service ❑Propane gas: <Pl lb. tank (as in home HBO grill) 33 ®Medical use 5 C Se rv.0 re as.- Gasoline: vehicle fuel tank n I_ICivilian) I I I 3 ❑ r portable container 40 Residential use ❑EMS-6 5 1 Row of stores H2 Detector 4 ['Kerosene: fuel burning equipment or portable storage 53 ®Enclosed mall 0HazMat-7 5 Required for Confined Fires. oil fuel tank or portable ['Diesel fuel/fuelil 58 —Bus. Ee Residential Wildland Fire-8 "Detector alerted occupants 6 ['Household solvents: home/nffine spill, cleanup only 59 Office use El Apparatus-9 7 ❑Motor oil: from engine or portable container 60 ® Industrial use 63 — military use 0Personnel.-10 2❑netector aid not alert them n ®paint: from paint cans totaling e 55 gallons 0Arson-11 U❑Unknown ❑ or gal., 05 —Farme use 0 Other: Special HazMat actions required spill � ss ®0 ®Other mixed use Please complete the HazMat form J Property Use* Structures 341❑Clinic,clinic type infirmary 53912 Household goods,sales,repairs 34 2❑Doctor/dentist office 57 9 ❑Motor vehicle/boat sales/repair 133. ❑Church, place of worship 36 1❑Prison or jail, not juvenile 577, ❑Gas or service station 161 ❑Restaurant or cafeteria 4190 1-or 2-family dwelling 599 El Business office 162 ❑Bar/Tavern or nightclub 42 9❑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 ❑Manufacturing plant 241 ❑College, adult education 459❑Residential, board and care 819 ❑Livestock/poultry storage(barn) 3 11 ❑Care facility for the aged 464['Dormitory/barracks 882 ❑Non-residential parking garage 331 ❑Hospital 519❑Food and beverage sales 89 1 ❑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 1962 1 919 ❑Dump or sanitary landfill 961 ❑Highway/divided highway 931 ❑Open land or field 962 ®Residential street/driveway (Residential street, road or NFIRS-1 Revision 06/03/05 FIRE RESCUE 07009 02/26/2007 07-0018854 Ki Person/Entity Involved I L_____ J _ L-__I_I l Local Option Business name (if applicable) Area C de Phone Number 1 1 1 I U I 11 ___J ❑Check addThisress BOXas if Mr.,Ma., Mrs. First Name MI Last Name Suffix same incident location. I J I. , , J I , Then skip the three duplilinescate address Number Prefix Street or Highway Street Type Suffix Post Office Box Apt./Suite/Room City I I I-I I State Zip Code More people involved? Check this box and attach Supplemental Forms (NFIRS-1S) as necessary K2 Owner ❑ Same as person involved? Then check this box and skip _ The rest of this section. 1 I � I - I 1. �__ 1 Local Option Business name (if Applicable) Area Code Phone Number I I I I I-J I __J I I ❑ Check this box if Mr.,Ms., Mrs. First Name MI Last Name Suffix same address as I I incident location. I Number 1 U I I 1 1 1 Then skip the three duplicate address prefix Street or Highway Street Type Suffix lines. , I , , i J Post Office Box Apt./Suite/Room City I I I I-I I State Zip Code L Remarks Local Option On 02/26/2007 at 11:06:10 dispatched To 01700 HUNTINGTON RD WATERLOO, IA 50703 . The location is a Residential street, road or residential driveway. The incident was determined to be a Power line down. 11:10:00 arrived on scene. The following actions were performed on scene: Remove hazard Units responding were: Unit 304 responded. 11:10:00 all units back in service. Cable TV wire in roadway. Moved off road. I L Authorization 1JUNK,M 1 ' Junk, Michael I ILT I I 304 1 I 021 1261 1 20071 Officer in charge ID Signature Position or rank Assignment Month Day Year Check © I I I I I I I I I 1 I 1 L 1: Box if JUNK,M 'Junk, Michael LT 304 02262007 same - - - Position or rank Assignment Month Day Year as Officer Member making[--- report ID Signature in charge. FIRE RESCUE 07009 02/26/2007 07-0018854 i MM DD yyyy ElDelete r_11:::,* i IIA I 102 1 1 261 I 2007J 16 1 107-0018913 1 1 0001 NFIRS -1 State* Incident Date * Station Incident Number * Exposure ®Change Basic ❑No Activity n uei 'uY.�u.�aCa-' ueRL ,n pP'v Location*B IModule'Is Section 5 ^AlternativeLLeostion'Specification.1 Use only forLLaildlandefiresjaj,u ri'e Census Tract 0013 _ ®2 ®Street address jt 1 033571 1 11WEST RIDGE DR ❑Intersection Number/Milepost Prefix 1 I I� ❑In front of p Street or Highway Street Type Suffix JRear of I 1 LWATERLOO 1 'IA 1 150703 1-1 1 Apt./Suite/Room City State Zip Code ❑Adjacent to ❑Directions -_1 Cross street or directions, as applicable ti y, Secondary Address El C Incident Type * Midnight is 0000 Date & Times E2 Shift & Alarmr 1444 I 'Power line down I Check boxes if Month Da Year Hr Min Sec Local Option Incident Type dates are the Y same as Alarm ALARM always required lB I oil [6 D Aid Given or Received* Date. Alarm * 1 021 I 261 I 20071113:42:39 1 Shift or Alarms District Platoon ARRIVAL required, unless canceled or did not arrive 1 ❑Mutual aid received I II I ® Arrival * 1 021 I 261 ( 20071113:47:00 ' �3 • --_ 2 ❑Automatic aid recv. Their FDID Their State CONTROLLED O 3 ❑Mutual aid given ptional, Except for wildland fires Special Studa.esl 4 ❑Automatic aid given ( I 'Controlled I 021 I 261 I 20071114:00:001 Local Option 5 ❑Other aid given Their LAST UNIT CLEARED, required except for wildland firesI Incident NumberLast Unit ®None ® Cleared I 021 I 26J ' 20071114:00:00 1 Special Special DE 1 ( Sudy NValue 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 Personnel form is used. for non fires. None [84 I 'Refer to proper I Apparatus Personnel property $1 1 , I 0001 ,1 0001 ❑ Primary Action Taken (1) Suppression I I I 1 Contents $1 1 , 1 0001,1 0001 ❑ 186 I 'Investigate Additional Action Taken (2) EMS I 1 I I PRE-INCIDENT VALUE: Optional I. 11 I Other I 00011 I 00031 Property I I , I 0001,1 0001 ElAdditional Action Taken (3) ❑ Check box if resource counts include aid received resources. Contents $I I , I 0001,I 0001 ❑ Completed Modules Hl*Casualties❑None H3 Hazardous Materials Release 1 Mixed Use Property ❑Fire-2 Deaths Injuries N I None NM X Not Mixed ❑Structure-3 Fire 10 Assembly use 1 I I I 1 ❑Natural Gas: slew leak, no evsuation or HazMat actions 20 'Education use ❑Civil Fire Cas.-4 service 2 ❑pro ant p gas: <u lb. tank (as in home HBQ grill) 33 Medical use ❑Fire Serv. Cas.-5 Civilian' I I I 3 ❑Gasoline: vehicle fuel tank or portable container 40 _®Residential use ❑EMS-6 4 ❑Kerosene: fuel burning equipment or portable storage Si ®Row of stores I2 Detector 53 Enclosed mall ❑HazMat-7 5 ❑Diesel fuel/fuel oil fuel tank or portable Required for Confined Fires. 58 Bus. & Residential ❑wildland Fire-8 ❑ 6 ❑Household solvents: home/office spill, cleanup only 1 Detector alerted occupants p 59 Office use ®Apparatus-9 7 ❑Motor oil: from engine or portable container 60 —Industrial use ®Personnel-1.0 2❑Detector did not alert them 63 Military use 8 ❑Paint: from paint cans totaling< 55 gallons 6 ® 5 Farm use ❑Arson-11 U❑Unknown 0 Other: special HazMat actions required or spill a 5sgal., ❑ 00 i Other mixed use .� Please complete the HazMat form 3' 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 3610 Prison or jail, not juvenile 571 ❑Gas or service station 161 ❑Restaurant or cafeteria 419 1-or 2-family famil Y dwelling 599 [' Business office 162 ❑Bar/Tavern or nightclub 429 Multi-famil ❑ y 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 ❑Manufacturing plant 241 ❑College, adult education 459❑Residential, board and care 819 ❑Livestock/poultry storage(barn) 311 OCare facility for the aged 464®Dormitory/barracY.a 882 ®Non-residential parking garage 331 ®Hospital 519❑Food and beverage sales 4 891 ❑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 669 Forest (timberland) Lookup and enter a Property Use code only if 951 ❑Railroad right of way you have NOT checked a Property Use box: 807 ❑Outdoor storage area 960 Other street ❑ Property Use 1419 919 ❑Dump or sanitary landfill 961 ❑Highway/divided highway l 931 ❑Open land or field 962 ❑Residential street/driveway 11 or 2 family dwelling NFIRS-1 Revision 06/03/05 FIRE RESCUE 07009 02/26/2007 - 07-0018913 K1 Person./Entity Involved I I I I - I I-I Local Option Business name (if applicable) ' I Area Code Phone Number Check This Box if I I I I L�J I I I�l same address as Mr.,Ms., Mrs. First Name MI Last Name Suffix incident location. I I I I I I I I Then skip the three duplicate address Number Prefix Street or Highway lines. Y Y Street Type Suffix I I I I I I Post Office Box Apt./Suite/Room City U I I-I J State Zip Code EMore people involved? Check this box and attach Supplemental Forms (NFIRS-1S) as necessary K2 Owner n Same as person involved? I El Then check this box and skip I I I I - I I L______I The rest of this section. Local Option Business name (if Applicable) Area Code Phone Number I I I I i_J I I I_I Check this box if Mr.,Ms., Mrs.-First Name MI Last Name Suffix I same address as I incident location. I I L-1 I Then skip the three duplicate address Number Prefix Street or Highway I I Street Type I Suffix I I I I I Post Office Box Apt./Suite/Room City ti L_._J I I- I State zip Code L Remarks Local Option Engine 306 responded to a report of an electrical wire arching in the back yard. Upon arrival met at road by homeowner who states a wire in his back yard broke and landed on the ground on Saturday and burned a mark in his lawn but has been laying quietly until now. He heard a load buzz in his home and saw the wire arcing again in his yard. Investigation reveals a power line still live inside of his fenced in back yard. Home owner states that Mid America had been notified on Saturday but has not been able to come by as of yet. The wire was contained inside of his fence with no other access to it at this point. Owner states he was going to be home until tomorrow and would be able to keep an eye on it from inside of his home. He was advised to contact the fire dept. again if the wire started to burn into the pole or tree. Owner also agreed to advise his neighbors as to the danger. Dispatch was asked to advise Mid America as to the current condition of the wire. s L Authorization _�_.m_ IWOELBER,D I IWoelber, Dean I ILT I I I I 021 1261 1 20071' Officer in charge ID Signature Position or rank Assignment Month Day Year I Check Box if® I WOELBER,D I IWoelber, Dean 1 I LT _J I 11 021 1261 I 20071 same Position or rank Assignment Month" Da Year as officer Member making report ID Signature 9Y in charge. FIRE RESCUE 07009 02/26/2007 07-0019913 i A MM DD YYYY - ❑Delete 07009 i IIA I 102 11281 I 2007 I 13 I 1 07-0019569 I I 0001 NFIRS -1 FDID * State* Incident Date * Station Incident Number ❑Change Basic Exposure No Activity BLocation* Module In Section B "Alternative Location Specification". Use only for Wildland fires. CenSuS Tract 0017 _ ®1 Street address `;j L 11091 1 1 [LOGAN IRR �� I �v _I l l ®Intersection Number/Mile ost Prefix ' P Street or Highway Street Type Suffix ❑In front of. ['Rear of L I (WATERLOO 1 IIA 1 150703 I-1 I Apt./Suite/Room City State Zip Code ❑Adjacent to ❑Directions 1 Cross street or directions, as applicable I I , Secondary Address .J ' "� `°� POW line dOWn ..<. ,.,.....:.. v �eck box .,,.. .» ...... <,..,._ .. _. _ . ,. ..w.„ . __. .. .�.... ............_ c Incident Type * Midnight is 0000 E2 Shift a Alarm Date & Times I444 I I [ es if Month Da Year Hr Min Sec Local Option Incident Type dates are the Y _ same as Alarm ALARM always required L.--- . -I 1 9 1- Li D Aid Given or Received* Date. Alarm * I 021 I 281 1 20071108:46:59 I Shift arms or Alarms District Platoon ARRIVAL required, unless canceled or did not arrive 1 ['Mutual aid received i jj Arrival * I 021 I 281 I 20071108:52:00 I E3 2 ['Automatic aid recv. Their FDID Their State CONTROLLED O 3 ['Mutual aid given ptional, Except for wildland fires Special StudieSl 4 ❑Automatic aid given I 1 ®Controlled 1 021 1 281 1 20071108:54:00 .1 Local Option 5 ❑Other aid given Their LAST UNIT CLEARED, required except for wildland fires Incident Number Last Unit Special"-- N None Special III Cleared 1 021 1 281 1 20071108:58:00 I study IDtt Study Value F. Actions Taken * Gi Resources * G2 Estimated Dollar Losses & Values Pg]Ivl Check this box and skip this section if an Apparatus or LOSSES: Required for all fires if known. Optional 86 1 (Investigate Personnel form is used. for non fires. None Apparatus Personnel property $1 1 , 1 0001,I 0001 ❑ Primary Action Taken (1) l Suppression I 1 1 I Contents $1 LI 0001,1 0001 ❑ I 11 ( Additional Action Taken (2) EMS 1 I 1 1 PRE-INCIDENT VALUE: Optional I I I I Other I 00011 1 0003.1 Property $1 1 • I 001)._1•1 0001 ❑ Additional Action Taken (3) ❑ Check box if resource counts include aid received resources. Contents $1 1 , 1 0001,1 0001 ❑ Completed Modules Hl*Casualties❑None H3 Hazardous Materials Release I Mixed Use Property ❑Fire-2 Deaths Injuries 7 N EINone NN X Not Mixed ❑Structure-3 Fire 10 Assembly use I I 1 ['Natural Gas: slow leak, no evauation or Barat actions 20 —Education use ❑Civil Fire Cas.-4 Service I J® �J 2 ❑Propane gas: <21 lb. tank (as in home BBQ grill) 33 Medical use ❑Fire Serv. Cas.-5 Civilian) 1 1 I 3 ['Gasoline: vehicle fuel tank or portable container 40 ®Residential use GEMS-6 4 ['Kerosene: fuel burnin equipment 51 Row of stores H2 Detector9 qn pment or portable storage 53 ,>E.Enclosed mall ❑HazMat-7 5 ['Diesel fuel/fuel oil:vehicle fuel tank or portable Required for Confined Fires. 58 ®Bus, & Residential ❑Wildland Fire-8 6 Household solvents: ❑ home/office spill, cleanup only S Q m Of f1Ce use 1 Detector alerted occupants ®Apparatus-9 7 ❑Motor oil: from engine or 60 --Industrial use portable container ®Personnel.-10 2®Detector did not alert them 8 63 Military use El Paint: from paint cans totaling e 55 gallons 65 Farm use ❑Arson-11 U❑Unknown 0 ❑Other: special BaoMat actions required or spill > 55gal., 00 Other mixed use Please complete the MarMat form J' Property Use* Structures 341❑Clinic,clinic type infirmary 539 [I Household goods,sales,repairs � 3420 Doctor/dentist office 579 ❑Motor vehicle/boat sales/repair 131 ['Church, place of worship 3 61❑Prison or jail, not juvenile 571 ❑ Gas or service station 161 ❑Restaurant or cafeteria 4 19 1-or 2-family ❑ dwelling 599 ❑ Business office 162 ❑Bar/Tavern or nightclub 429 ldulti-famil dwel ❑ y dwelling 615 ❑Electric generating plant 213 ❑Elementary school or kindergarten 4390 Rooming/boarding house 629 Laborator 215 ['High school or ❑ y/acien.ce lab ❑ g junior high 449 Commercial hotel or motel 241 El College, adult education ❑ mm 7 00 ❑Manufacturing plant 45 9❑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 Li Warehouse Outside 936 ❑Vacant lot 9$1 ❑ 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 669 ['Forest (timberland) 961 Railroad right of wayLookup and enter a Property Use code only if ❑ g you have NOT checked a Property Use box: 807 ['Outdoor storage area 960 Other street ❑ Property Use 1000 1 919 ['Dump or sanitary le:ndf ill 961 ['Highway/divided highway 931 ['Open land or field 962 ['Residential street/driveway (Property Use, Other I NFIRS-1 Revision 06/03/05 FIRE RESCUE 07009 02/28/2007 07-0019569 /C1 Person/Entity Involved I I L____—I - I I_L___Local Option Business name (if applicable) Area Cdde Phone Number ciCheck This Box if I I I I U I i 1� Same address as Mr.,Ms., Mrs. First Name MI Last Name Suffix incident location. I I I I I I I I L� Then skip the three duplicate address Number Prefix Street or Highway Street Type Suffix i I I I I I I Post Office Box Apt./Suite/Room City III I-I I J State Zip Code I UPQore people involved? Check this box and attach Supplemental Forms (NFIRS-1S) as necessary K2 Owner D Same as person involved? Then check this box and skip I I I I - I I L__________J The rest of this section. Local Option Business name (if Applicable) Area Code Phone Number I I I I I I I I I I IEl Check this box if Mr.,Ms., Mrs. First Name MI Last Name Suffix same address as incident location. I Then skip the three I I U I I ( ( (_I duplicate address Number Prefix Street or Highway Street Type Suffix lines. I I I ( ( . Post Office Box Apt./Suite/Room City U I I-I I State Zip Code — L Remarks �.- _- — .__ w._ R .x._._.�. .._ Local Option Responded for a wire down. On scene found a tree branch had taken a wire down. The branch was laying on a van and had the wire along side of it. It was still attached to the house and live. No fire or sparking. I told dispatch to call Mid American and give them the details. L Authorization { I HARTER,B — I 'Harter, Bill I ILT I I I I 021 12111 20071. Officer in charge ID Signature Position or rank Assignment Month Day Year Check ® I 1 I I ILTI I I I I I I I I Box if HARTER,B Harter, Bill 02 28 2007 { same Position or rank Assi nment Month Da Year as Officer Member making report ID Signature 9 �' in charge. FIRE RESCUE 07009 02/28/2007 07-0019569 1