Facility Fire Occurrence Notification

Division of Waste Management (DWM) - Solid Waste Section

This form is used for solid waste management facilities to submit to the Division of Waste Management (DWM) Solid Waste Section a written notification of a fire at a solid waste management facility. Verbal notification is required within 24 hours of the fire. This form must be submitted to DWM within 15 days of the fire.
County:*(?)field type drop-down
Permit/Site ID:*(?)field type drop-down
Facility Name:*field type single line
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Date of Fire:*field type date
Time of Fire:*field type time
Reporting Method:*field type single line
How was the fire initially reported to DWM?
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Who reported the fire to DWM?*field type single line
Provide the name of the person who gave 24-hour notice to DWM:
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Title/Affiliation:*field type single line
Provide the title or site affiliation of the person who gave 24-hour notice to DWM:
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DWM Staff Notified:*field type multi line
Provide the name of the DWM staff person that was given 24-hour notice:
Location:*field type single line
Where at the facility did the fire occur?
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Type(s) of Waste:*field type single line
What type(s) of waste caught fire?
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Amount of Waste:*field type single line
Estimate the amount of waste that was burning:
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Units:*field type radio button
Units:tonscu yds
Size of Fire:*field type single line
Estimate the size of the area that was burning:
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Units*field type radio button
Unitsacressq ft
Cause of Fire:*field type multi line
What was the cause of the fire?
Actions Taken:*field type multi line
List the actions taken to put out the fire and minimize damage:
Could fire have been prevented?*field type multi line
What could have been done to prevent this fire?
Plan for Prevention:*field type multi line
Describe the plan of action to prevent future incidents:
Name:*field type single line
Provide the name of the person submitting this form:
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Title/Affiliation:*field type single line
Provide the title or site affiliation of the person submitting this form:
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Phone:*field type single line
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Email:*field type email
Date:*field type date
Date will be captured on form submission
Inspector LFID:*field type single line
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Inspector Email:*field type email
Supervisor LFID:*field type single line
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Supervisor Email:*field type email
Compliance Officer LFID:*field type single line
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Compliance Officer Email:*field type email