1. Incident Name

2. Operational Period (Date/Time)

Assignment List

ICS 204- EPA
3. Branch

4. Division/Group/Staging

5. Operations Personnel
Name	Affiliation	Contact # (s)
Operations Section Chief:
Branch Director:
Division/Group Supervisor/STAM:
6. Resources Assigned	“X” indicates 204a attachment with additional instructions
Strike Team/Task Force/Resource Identifier	Leader	Contact Info. #	# of Persons	Reporting Info/Notes/Remarks
7. Work Assignments
8. Special Instructions
9. Communications (radio and/or phone contact numbers needed for this assignment)
Name/Function	Radio: Freq./System/Channel	Phone	Cell/Pager
Emergency Communications
10. Prepared by

Date/Time

11. Reviewed by (PSC)

Date/Time

12. Reviewed by (OSC)

Date/Time

ASSIGNMENT LIST
ICS 204- EPA (Rev 04/07)

1

s.eddy

2013-06-26

Dept of Ecology