Air Quality Bureau P.O. Box 200901 Helena MT 59620-0901 (406) 444-3490 FIREFIGHTER TRAINING OPEN BURNING NOTIFICATION 1. General Information Name of Fire Department: Firefighter Open Burning Permit Number: Mailing Address: MT PO Box or Street Address City State Zip Code Contact Person: Telephone Number: FAX Number: Email Address: 2. Burn Site Information MT Physical Address: Street Address City State Zip Code Legal description of burn site: Section, Township, Range County Adjacent land use: Industrial, Residential, Agricultural/undeveloped, etc. d. Distance and direction to nearest residence or other sensitive areas (schools, hospitals, etc.): 3. Details of Proposed Burn Start Time: End Time: Burn Date(s): Types of Fuels and Materials to be Burned (check all that apply) Oil or Petroleum Products (specify) Insulated Wiring Tires, Asphalt Shingles, Tar Paper Automobile or Aircraft Bodies and Interiors Chemicals (specify) Standing or Demolished Structures Other (specify) Estimated Quantity of Fuel/Materials: Have all reasonably removable prohibited materials been removed? Yes No Have all asbestos containing materials been removed? Yes No Not Applicable Have adjacent landowners been notified of proposed burns? Yes No 4. Educational objective of the exercise: 5. Fire Department Representative Authorized Signature: Authorized Signature Printed Name Date FFOB_Notification_Form.docx 1 of 1 Revised: 10/01/2013
Air Quality Bureau P.O. Box 200901 Helena MT 59620-0901 (406) 444-3490 FIREFIGHTER TRAINING OPEN BURNING NOTIFICATION 1. General Information Name of Fire Department: Firefighter Open Burning Permit Number: Mailing Address: MT PO Box or Street Address City State Zip Code Contact Person: Telephone Number: FAX Number: Email Address: 2. Burn Site Information Physical Address: MT Street Address City State Zip Code Legal description of burn site: Section, Township, Range County Adjacent land use: Industrial, Residential, Agricultural/undeveloped, etc. d. Distance and direction to nearest residence or other sensitive areas (schools, hospitals, etc.): 3. Details of Proposed Burn Burn Date(s): Start Time: End Time: Types of Fuels and Materials to be Burned (check all that apply) Oil or Petroleum Products (specify) Insulated Wiring Tires, Asphalt Shingles, Tar Paper Automobile or Aircraft Bodies and Interiors Chemicals (specify) Standing or Demolished Structures Other (specify) Estimated Quantity of Fuel/Materials: Have all reasonably removable prohibited materials been removed? Yes No Have all asbestos containing materials been removed? Yes No Not Applicable Have adjacent landowners been notified of proposed burns? Yes No 4. Educational objective of the exercise: 5. Fire Department Representative Authorized Signature: Authorized Signature Printed Name Date FFOB_Notification_Form.docx 1 of 1 Revised: 10/01/2013
FFOB_Application.docx