INCIDENT DETAILS: Fire Start Date: Fire Start Time: IC’s Name: Invoice Fire Name: Date: Invoice Fire #: #: STATE OF Energy, Minerals and Natural Resources Department County: Financial Code: JPA #: Forestry Division 1052123000015 Ownership: FIRE DEPARTMENT REIMBURSEMENT REQUEST Cover Type: Fuel Type– (what actually burned): General Cause: Other Structures Threatened Number and Type: Number of Structures Burned: Fire Location: T. R. Section 1/4Section and/or Latitude Longitude Acreage Burned by Land Ownership: (number of acres in blanks) BIA BLM FWS NPS Private State USFS Other (specify) Dispatch: Date Time Acres Initial Attack: Date Time Acres Controlled: Date Time Acres Back To Station: Date Time Acres Slope at Origin: Aspect at Origin: Temperature: (°F) RH: % Wind Speed: Wind Direction: Fire Behavior on Initial Attack: FORM COMPLETED BY TITLE DATE
STATE OF Energy, Minerals and Natural Resources Department Forestry Division FIRE DEPARTMENT REIMBURSEMENT REQUEST Fire Name: Fire #: Invoice Date: Invoice #: Financial Code: JPA #: 1052123000015 INCIDENT DETAILS: Fire Start Date: Fire Start Time: IC’s Name: County: Ownership: Cover Type: Fuel Type– (what actually burned): General Cause: Other Structures Threatened Number and Type: Number of Structures Burned: Fire Location: T. R. Section 1/4Section and/or Latitude Longitude Acreage Burned by Land Ownership: (number of acres in blanks) BIA BLM FWS NPS Private State USFS Other (specify) Dispatch: Date Time Acres Initial Attack: Date Time Acres Controlled: Date Time Acres Back To Station: Date Time Acres Slope at Origin: Aspect at Origin: Temperature: (°F) RH: % Wind Speed: Wind Direction: Fire Behavior on Initial Attack: FORM COMPLETED BY TITLE DATE
QuayCounty_FireReimbursementform.docx