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Attachment D <br />Page 8EMERGENCY CONTINGENCY PLAN <br />Ramsey County Household Hazardous Waste Incident Reporting Form <br />Type of Incident:Date and Time of Incident <br />AccidentDate <br /> Fire Time <br />Explosion <br />Release of Hazardous Material <br />______ Suspicious Container or Unstable Material (Non-Release) <br />Location of incident: <br />Does the incident threaten the environment? No. If yes, explain: <br />__________ <br />Areas evacuated: <br />__________ <br />Extent of damage: <br />________________ <br />Is outside assistance required? No Yes <br />If yes, please mark: Fire MPCA Police <br /> EPA Hospital Chemtrec <br /> Other <br />Personnel injured: No. If yes, explain: <br />__________ <br />Response plan adequate? Yes. If no, explain: <br />_____ <br />Name and title of person reporting: <br /> <br />Name Title <br />June 2021J120584 <br /> <br />