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40 <br />Qb <br />r <br />5. Action taken to respond or contain <br />0 <br />7 <br />Potential Health Risk (If known or anticipated) <br />A. Off -Site <br />B. injuries: Release Related/Number <br />Non -Release Related/Number <br />Recommended Protective Actions (where appropriate advise regarding attention <br />necessary for exposed individuals) <br />8. Agencies Notified by Industr <br />A. <br />County E.M. <br />D. <br />State DER <br />B. <br />Local F.D. <br />E. <br />State DNR <br />C. <br />Local Environmental— <br />F. <br />Other <br />S, Emergency <br />Assistance Requested; <br />Yes / No; If Yes. <br />A. <br />Local F.D. <br />E. <br />Local Health <br />B. <br />Local E.M. <br />F. <br />State DNR <br />C. <br />Local Environmental— <br />G. <br />State DER <br />D. <br />Local Law Enf, <br />H. <br />Other <br />10. Should <br />more than 15 minutes difference exist between release beginning time <br />( <br />) and reporting time ( <br />), <br />explain reason for not immediately <br />reporting <br />the incident <br />1 1. Message Recelvetl : name I nriC L OLO <br />THIS DOES NOT FULFILL THE REQUIREMENTS FOR A FOLLOW-UP REPORT <br />Indian River County Emergency Flan for Hazardous Materials Pace 82 <br />