1. Incident Name

2. Operational Period (Date/Time)

From: To:	ASSIGNMENT LIST ATTACHMENT
ICS 204a- EPA
3. Branch

4. Division/Group

5. Strike Team/Task Force/Resource (Identifier)

6. Leader

7. Assignment Location

8. Work Assignment Special Instructions, Special Equipment/Supplies Needed for Assignment,

Special Environmental Considerations, Special Site Specific Safety Considerations
Approved Site Safety Plan Located at:
9. Other Attachments (as needed)
Map/Chart	Weather Forecast
10. Prepared by

Date/Time

11. Reviewed by (PSC)

Date/Time

12. Reviewed by (OSC)

Date/Time

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

1

s.eddy

2013-06-26

Dept of Ecology