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ACTION REQUEST FORM


- 11qx
(Interim draft as of 1/03
. Who is Requesting Assistance? (Completedby Requestor)
tequestor Name/Title/Statc: Meegan Nagy Temporary PhoneIFax #:

'errnanent Phone:

tequestor Organization: ESF #3 E-mail:


I. Requested Assistance (Completed by Requestor) See Attached

Icscrlption of Assistance Requcstcd: -


tequest to provide assistance to return the German unwatering team arid equipment back to home station. See attached ernail
1s justification.
ILG3PP- LA-c~k-MVfiiI
)uantity: Priority: 1 Lifesaving 2 Life sustaining Date/Time Needed:
3 High fl 4 Medium 17 5 Normal 20-Oct-01
Ielivery Site Location:

&
%
A.
-
-- -
--
-
-
site POC: Meegan Nagy 24 Hour Phone: i-
- FAX #
Itate Approving Official signature: Date:

111. Sourcing the Request - Review/Coordination (Operations Section Only)


Donations Procurement

0Other (explain) fl InteragencyAgreement


3 0the.i Coordination by: Requisitions s o n Assignment
3 Other Coordination by:
7 Other Coordination by:
mmediate Action Required: U Yes No Action request 2 ESF#: 3
Iate/Time Assigned: I assigned to: Other:

:V:Statement of Work (Operations Section Only)


)FA Action Officer: 24 hour Phone: FAX#
'EMA Proiect Officer: 24 hour Phone: FAX#
lustification / Statement of Work:

Cst~matedCompletion Date: Cost Estimate:


J . Action Taken (Operations Section Only)
? Accepted C? Rejected 1 Accountable Property
>isposition: Coordinated with APO

rRACKING INFQRMATION (FEMA USE ONLY)


IEMIS Task ID.
i c l ~ o t lReouest 11 I~eceivcdbv (Nc~mcand Oreantzat~on)
'i-ogl-am Code/ Event #: State: Datr/Time Submitted: 1 1 _I Or~ginatedas verb;

ARF - German Unwatering crew.xls


3 0 t - L
ACTION REQUEST FORi (Interim draft as of 1/03
. Rihc, is Requesting Assistance? (Completed by Requestor)
I ~ e ~ u e s t ~o kr n e l ~ i t l e j ~ t a t e : Charlie Tobin/ESFX3 ATL/LA Temporary hone/^- -
v
I
Permanent Phone: P A X #. '

Scope of work on attached sheet.

--. -
-
- 9

--Y

i
n Log-by: -,
v-
.flc!mer (Wan) InteragencyAgreement
0 other~oord~natlon
by: 0 Rwlsrtlorn 0 ~sslonw n m e n t
Othermmtbnby:
by:
~tfier~owdinatltln

Immediate Action Required: U yes No Action request W #:


Date/Time Assigned: assigned to: Other:

IV: Statement of Work (Operations Section Only)


OFA Action Officer: 24 hour Phone: FAX#
--

FEMA Project Officer: 24 hour Phone: FAX#


Justification / Statement of Work:

ARF water 1
I ACTION REQUEST FORNI
fa- 1089
(Interim draft as of 1/03)]
11. Who is Requesting Assistance? (Comvletedbv Reauestorl I
I
equestor Narne/Title/State: Kerri Stark Temporary Phone/Fax #:
___.
IPermanent Phone:

-
IRequestor Organization: ESF #3 -
--
111. Reauested Assistance lCom~letedbv Reauestorl I7 see~aachedq
l ~ e s c r i ~ t i oofnAssistance Requested:
LOGISTICS PLANNING RESPONSE TEAM (PRI) SUPPORT TO FEMA LOGISTICS (Federal Operations Support).

Amendment 03 to increase mission by $1M to total $3M. See attached justification


Quantity: Priority: 0 1 ~ifm 2We~stahbg Date/Time Needed:
• 3 High 04bk&nn 5Normal
Delivery Site Location:

Site POC:
&

& A -
-=
--
- 24 Hour Phone: FAX #
l ~ t a t Approving
e Official signature: Date:

-
111. Sourcing the Request Review/Coordination (Operations Section 0 4 y )
Proar-t

Interagencv ag-
0 ~ t h e r ~ o o r ~ i ~ b y : 0Requ- /0~i&~ion-~ment
0 Other Coordinationby:
1 CI Other Coordrnabon by: AM FA^^
,Immediate Action Required- U Yes 0 NO

FAX#
FAX#

Original Amount for

l~mendrnent03 to be submitted for $ l M to increase rnssion to $3M I


l~urn rate: Currently have 50 people. This is $50K charged to the mission per day. I
IThis amount will fund 50 people for 30 days.

Estimated Completion Date:


- -

1
---

Cost Estimate:
I
V. Action Taken (Operations Section Only)
0Accepted a Rejected 10 Accountable Property
Disposition:

TRACKJNG INFORMATION (FEMAUSE ONLY)


NEMlS Task ID: /SOY-
C/D 7 747
Action Request # Received by (Name and OrganizationJ:
Program Code/Event #: State: (~ate/~irn Subm~tted:
e 1 0 Originated as verbal
ARF - LPRT increase mission to 3M.xls
L

Justification for Logistics Mission Assignment Increase ..


Original Amount for Logistics MA: $M
Amendment 01 to increase MA from $ l M to $2M.
Amendment 02 to change end date from 30 Sept 05 to 3 1 Dec 05.
Amendment 03 to increase MA fiom $ l M to $3M

Amendment 04 to be submitted for $ I S M to increase mission to $4.5M.

Bring in 50 more QA's for logistics


Bum rate: ..- 50 people at $50K per day.

. -.--..
Ho"wlo@ will this amount last - 30days.
L f

Requestor Name/Title/State:

Permanent Phone.
Requestor Organization:
, ESF #3
Meegan Nagy

11. Requested Assistance (Completed by Requestor)


Description of Assistance Requested:
ACTION REQUEST FORM
I. Who is Requesting Assistance? (Completed by Requestor)
Temporary Phone/Fax #:

FAX H:
E-mail:
I
-.
-
I
-
J r O 85q

-
(Interim draft as of 1/03)

See Attached

LOGISTICS PLANNING RESPONSE TEAM (PRV SUPPORT TO FEMA LOGISTICS (Federal Operations Support)
1603-DR-LA-COE-MVD-13
Amendment 02 to change end date from 9-30-05to 12-31-05.
Quantity. Priority. 1 Lifesaving 0 2 hfe sustaining Date/Time Needed.
I3 3 H Q ~ [7 4 Medium 0 5 Normal
Delivery Site Location:
-
--. --
----
-
-

Site POC: 24 Hour Phone: -- FAX #


-
State Approving Official signature:
- Date:

-
111. Sourcing the Request Review/Coordination (Operations Section Only)
I
FOPS
Review by: F- 0&mations 0Procurement
LogRwiewby: Other (explain) 0InteragencyAgreement
Other Coordination by: 0Requisitions d n nnignrnent
Other Coordination by: h--d&
0 Other Coordination by:
Immediate Action Required: U Yes No Action request #: 3
WESF
DatefTime Assigned: assigned to: Other:

IV: Statement of Work (Operations Section Only)


OFA Action Officer: 24 hour Phone: FAX#
FEMA Project Officer: 24 hour Phone: FAX#

Estimated Completion Date: I Cost Estimate:


V. Action Taken (Operations Section Only)
Ll Accepted @ Rejected In Accountable Propea
Disposition:

TRACKING I N F O R M A T ~ N(FEMAUSEONLY)
N E M I S Task ID: 1509- 28/71 i
Action Recluest # Received by (Name a r ~ dOrgamizal~on):
Program Code/Event #: State: I~ate/~irn
Submitted:
e Ifi Orig\natedas verbal
ARF - LPRT Amd to change date.xls
4Fo 6 3 s
t- CTION REQUEST FORM (Interim draft as of 1/ 03)
I. W h o is Requesting Assistance? (Completed by Requestor)
questor Name/Title/State: K e m Stark,Asst Team Leader, LA Temporary Phone/Fax # :

I
I

Permanent Phone: FAX#-\:


Requestor Organization: ESF (13 E-mail:
11. Requested Assistance (Completed by Requestor)
Description of Assistance Requested:
[ ~ c p l o yHousing Strike Team in response to Hurricane Katrina in the State of louisiana. 1603-DA-LA-COE-MVD-14.
- . I
lArnendment 0 1 to increase by $S.WO,WO total of $6,50O,WO (See attached)

Quantity: WktYr l~fesvlng 0 ~~fesustalning Date/Time Needed:


I
*~lgh 0 4~edium 5~amzd
Delivery Sjte Location:
.-
d~jr103Z T F O b'HJH~J SF^~cF-S '

Site POC: M&kmuntain 24 Hour Phone: , FAX#-


---

- I
tate Approving Official signature: Date:
-
-
III. Sourcing tLe Request Reviey/Coordination (Operations Section Oiily)
10 clf4mmmt

I
tion on by:
~Gxndiinaaonby:

Immediate Action Required: M Action request 0 M#:


Date/Time Assigned: / assigned to: 0 other:

Estmated Completion Date: I cost -ate:


V. Acti%n Taken (Operations Section Only)
&ed 0Rejeded 10 AaMmmh.operF/
Disposition:

1 Coordinated with APO

INEMIS Task ID: / g d 7- 3 b 1 a 4


a
*?

Action Request # Received by ( N a m e and Organization):


Program Code/ Event #: State: 1Date/Time Submitted: 4
1 originatedas ve&l

ARF - housing strike team increase 6.5M.xls


1
Justification for Housing Strike Team Mission Increase

t
Of the $ISM authorized for support to the strike teams, $1.4M has now been committed.
Commitment of dollars for strike team support has been used at a rate of about $500,000
per week. The additional $5Mwill support strike team activities for an addzional 10
weeks. The mission of the strike team will be re-evaluated in approximately 10 weeks to
determine need for additional funding.
-(1nte;im

-
7

-
ACTION REQUEST FORl, H f t as of 1/03)

I. W h o is Requesting Assistance? (Completedby Requestor)


Requestor Narne/Tltle/State: Mickey Fountain, Team Leader, LA Temporary Phone/Fax #: '-*
Permanent Phone: FAX#:
Requestor Organization: ESF#3 E-mad: -1

11. Requested Assistance (Completed by Requestor) See Attached

Description of Assistance Requested:


RECOVERY FIELD OFFICE (Federal Operations Support) - 1603-DR-LA-COE-MVD-16 Amendment 01 to Increase by $1,000,000
total of $2M.
-

Quantity: Priont~: a 1Ufesavlng 2 bfe sustalnlng Date/hme Needed:

-
3 High 4 Medium 0 5 Normal 9 / 13/2005
Delrvery Slte Location.

. --- - -

-Z.

Srte POC: ~icke~-Fountain 24 Hour Phone. FAX#

State Approving Oficial signature: -


-
<
Date:

-
111. Sourcing the Request Review/Coordination (Operations Section Only)
0 OPS Review by. Donabons C] Procurement
Log Review by: Other (explain) Interagency Agreement
0 Other Coord~natlonby: RequlsWons Mlsslon Assignment
Coord~natlonby:
Other
tj OUler Coardlnauon by:
Immediate Actlon Required: Yes No Action request E Y 1:
Date/Time Assigned: assigned to: Other:
IV: Statement of Work (Operations Section Only)
OFA Actron Offrcer. 24 hour Phone. FAX#

FEMA Project Officer: 24 hour Phone FAX#


Justificatlon / Statement of Work:

Estrmated Completion Date: Cost Estimate. "C

V. Action Taken (Operations Section Only)


Accepted [7 Rejected Accountable Property

,@vD YKQ
D~sposltlon: Coord~natedw ~ t hAPO

--
T R A C K X ~ G * I N F O ~ ~ T I O N~ ~S~ O(EK~ LE Y~"')+:. La 89
_. 2:L '
11' 7

$ r ?
i:

NEMIS Task ID /$&, 34756


Actlon Request # Received by (Name and Organlzat~on).
Program Code/Event # State: Date/T~mcSubmitted - I Originated as verbal
n,,, - 7 , .>,,,. ,,,>,. -- - - -
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ACTION REQUEST FORM (Interim draft as of 1/03)
I. Who is Requesting Assistance? (Completed by Requestor)
Requestor Narne/T~tle/State: Paul Krebs Temporary Phone/Fax #: - - \

Permanent Phone. FAX#:

Requestor Organization: ESF #3 E-mail: -1


11. Requested Assistance (Completed by Requestor) I3 see ~ttached
Description of Assistance Requested: >

-
PURCHASE & Distribubon of FUEL (Federal Operations Support) 1603-DR-LA-COE-MVD-17Amendment 01 to Increase by $1M
for total of $2 M.

Quant~ty: Priority: 1 ufesavllng a 2 ~ f wstainlng


e Date/Tnne Needed:
I
3 3 High 4 Med~um 5 Normal / -
5
,
Delivery Site Location:
Louisiana
.-
..- =
-
-
-
-
I: ,

S ~ t ePOC: Paul Krebs 24 Hour Phont

State Approving Official signature: Date:

Ill. Sourcing the Request - Review/Coordination (Operations Section Only)


@ OPSRaiewby:- 1 ~~onatrons 0Procurement
0 W R W W W ~ 0 Other (explam) Interagency Agreement
0 Other Coordmabion by: Requis~bons Mlnion Asngnrnent
Other Coardlnatlon by:
Other Coordlnatlon by:
,
Immed~ateAcbon Required: Yes No Achon request Q/ESF#: 3
Date/Time Ass~gned: asagned to: Other:

IV: Statement of Work (Operations Section Only)


OFA Acbon Officer: 24 hour Phone: FAX#
FEMA Project Officer: 24 hour Phone: FAX#
Justlficatlon / Statement of Work:

Increase amount to allow for purcahse of addit1onal200,OO gallons of fuel (from 300,000 to 500,000 gallons of fuel)

- U "/
Estimated Complehon Date: Cost Eshmate:
V. Action Taken (OperationsSection Only)
C]Accepted fl Re~ected 0 Accountable Property
D~spositlon: Coordinated wrth APO

TRACKING INFORMATION (FEMA USE ONLY)

mv\ .
N E M I S Task ID.
Action Request # '&q 4%
-- - Received by (Name and Organlzation)
Program Code/ Event #:
w
State: I ~ a t e / ~ ~ Subm~tted:
rne 1[7 Or~gtnatedas verbal
3 -1 S r ) I

ACTION REQUEST FORM (Interim draft as of 1/03)1

- I
I. Who i s Requesting Assistance? (Completed by Requestor)

Requestor Name/Title/State: Meegan Nagy Temporary Phone/Fax #:


- /

Permanent Phone: FAX A


#: - '
Requestor Organization: 41- E-mail: -

11. Requested Assistance (Comp~ereu


uj Requestor) see ~ttached
Descnpbon of Assistance Requested.
-
~REMOTESENSINGIGIS SUPPORT (Federal Operations Support) 1603DR-LA-COE-MVD-18 I
l ~ m e n d m e n02

Quanuty:
t to increase funds by $120,000 to totaI $320,000.00

PrlofitY: 1 Lifesaving n 2 Me sustaining Date/T~rneNeeded:


I
3 nigh 4 ~edlurn Cl 5 Normal
Delivery Site Location: -
--. - -
-- T

A-

Site POC: 24 Hour Phone: -= FAX#


-
State Approving Oflicial signature: Date:

111. Sourcing the Request - Review/Coordination (Operations Section Only)


(0 &/IPhom Procurement

Other (expla~n) Interagency Agreement


Other Coord~nationby: Requlslhons Mission Assignment
Other Coordinabon by:
C] Other Wrdlnabon by:
Immediatc Action Required: U Yes No Action request €SF #:
I ~ a t e / ~ i r nAssigned:
e
- - -
I assigned to: 0
-
Other:
-pp - - -
I
N: Statement of Work (Operations Section Only)
OFA Action Officer: 24 hour Phone: FAX#
I
FEMA Project Officer: 24 hour Phone: FAX#
Justification / Statement of Work:
Funds are needed to support 4 people at $1,000.00 per day for 30 days.

Estimated Completion Date: Cost Estimate:


V. Action Taken (Operations Section Only)
3 Accepted Rejected 1 Accountable Property

TRACKING INFORMATION (FEMA USE ONLY)


NEMIS Task ID: /n7 - 4/62 $/3 / I
Action Request # Received by (Name and Organization):
Program Code/ Event #: State: Date/Time Submitted: ..._' Orig~natedds verbdl

ARF - Remote Sensing G I s Amd to change date.xls


I ACTION REQUEST FORM
Tm 8Sh ,
(Interim draft as of 1/03)

(I. Who is Requesting Assistance? (Completed by Requestor) I


Requestor Name/Title/State: Meegan Nagy Temporary Phone/Fax #:

IPermanent Phone: FAX #: I


Requestor Organization: ESF #3 E-mal:
111. Requested Assistance (Completedby Requestor) % Attached

_ -
I
Description of Assistance Requested:
REMOTE SENSINGIGIS SUPPORT (Federal Operations Support) 1603DR-LA-COE-MVD-18
Amendment 0 1 to change end date from 9-30-05 to 12-31-05.

Quantity: Priority: 0 1 ~feravinp 0 2 Life sustaining Date/Time Needed:


- -
3 High n 4 Medium 05 N m a l
Dellvery S ~ t eLocation: .
.

A - -
. --
-
Z
T

Site POC: 24 Hour Phone: _ FAX #


- - - -
-
Approving Official signature:

-
1111. Sourcing the-Request ReviewlCoordination (Operations Section Only)
- Date:
II
0- OK Review by:% ~Mc; ,
0Donations Proairement

0 Log Review by:


Other Coordination by:
Other Coordination by:
Other (explain)
Requisitions z
P m& Inter gency Agreement

Other Coordination by:

Immediate Action Required: U Yes No Action request @-€SF #: 3


Date/Time Assigned: assigned to: 0 Other:

IV:Statement of Work (Operations Section Only),


OFA Action Officer: 24 hour Phone: FAX#
FEMA Project Officer: 24 hour Phone: FAX#
Justification / Statement of Work:

Est~rnatedCompletion Date: Cost Estimate:


V. Action Taken (Operations Section Only)
,- 7
,Disposition:
'1 Accepted Releaed 7 Accountable Property

TRACKING INFORMATION (FE- USE ONLY)


NEMlS Task ID: \ bq-. \ 5 38 8 2
Action Rccluest #
Program Code/Event #:
l ~ e c e i v e dby (Name and Organization):
(state: ( Datc/Time Subrnittcd: -
-
as verbal
Or~g~nated
I
ARF - Remote Sensing GIs Amd to change date.xls
i t b
S F 0 B67
I

-
, ACTION REQUEST FORM (Interim draft as of 1/03)
11. Who is Reauestine Assistance? ICom~letedbv Reauestor) 1
Requestor Name/htle/State: Meegan Nagy Temporary Phone/Fax #:

Permanent Phone: FAX#?


,
Requestor Organization: ESF #3 E-mail:
11. Requested Assistance (Completed by Requestor) See Attached

l ~ e s c r i ~ t i oofnAssistance Requested: I
l ~ r o v i d eEngineering and Construction Support As Directed By FEMA for DMORT (Direct Federal ~ s s l i t ~ c e )
' I
Amendement 0 3 to change end date from 9/30/05 to 12131/05
Quantity: Priority: 1 Lifesaving 2 Life sustaining Date/Time Needed:
3 High fl 4 Medium fl 5 Nomlal

I
Delivery Site Location:

=
Site POC: 24 Hour Phone: FAX #
I
State Approving Official signature:

-
-
-- Date:
I
In. Sourcing the Request Review/Coordination (Operations Section Only) I
Id Log Review by:
Other Coordination by: Requisitions
Procurement
Interagency Agreement
m ~ n i o Assignment
n
Other Coordination by:
Other Coordination by:
A d -
I
Immediate Action Required: U Yes No Action request O/ ESF #: 3
I~ a t e ~ ~ iAssigned:
tne assimed to: Other:
- - - -

IV: Statement of Work (Operations Section Only)


OFA Action Officer: 24 hour Phone: FAX#
I
EMA Project Officer: 24 hour Phone: FAX#
I
l~ustification/ Statement of Work:
I

I
Est~matedCornplction Datc: Cost Estimate:
V. Action Taken (Operations Section Only)
3 Accepted fi Rejected C Accountable Property
Disposit~on Coord~naledwith APO

TRACKING INFORMATION (FEMAUSE ONLY)


NEMIS Task ID: 1504 - 3 8 a ~ q
Action Request # Received by (Name and Organization):
Program Code/ Event #: State: I ~ a t e / T i i eSubmitted: 1 L' O r ~ g ~ n a t eads verbal

ARF - DMORT Amd to change date.xls P


-
- -
ACTION REQUEST FORM (Interim draft as of 1/03)
I. Who i*: Requesting Assistance? (Completed by Requestor)
Requestor Name/Tltle/State: Mickey Fountan, Team Leader, LA Temporary Phone/Fax #: 7
Permanent Phone: FAX #:

Requestor Organization: ESF#3 E-mad: , --

Ii. Requested Assistance (Completed by Requestor) See Attached


Description of Asststance Requested.
ENGINEERING & CONSTRUCTlON SUPPORT FOR DEMORT (Federal Operations Support) - 1603-DR-LA-COE-MVD-19
Amendment 02 to increase by $20,000,000 total of $31M.

Quantity. Priority: 1 Ltfe~v~ng 0


2 Life sustaining Date/Time Needed:
a 3 High 4~edium 5 Normal 9/ 13/2005
Dellvery Site Location:

--
-

---. -- i

Site POC: Mickey Fountan 24 Hour Phont- ' FAX # : r-'


-
-
State Approving OFficial signature: - Date:

111. Sourcing the Request - Review/Coordination (Operations Section Only)


0 OPS Rev~ewby: Donabons Pmrement
Log Review by: 0Mer (explain) 0interagency Agreement
Other Cmrdlnat~onby: RequisNons Mlssion Asstgnrnent
Other Coordination by:
0 Other Coord~nabonby:
Immediate Act~onRequired: Yes No Action request ESF #:
DatefT~rneAssigned: assigned to: Other:
Ilk Statement of Work (Operations Section Only)
OFA Actlon Officer: 24 hour Phone: FAX#
FEMA Project Officer: 24 hour Phone: FAX#
J u s t ~ f i c a t ~ o/ nStatement of Work:

Estimated Completion Date: Cost Est~mate:


V. Action Taken (Operations Section Only)
0Accepted Rejected Accountable Property

-ab- 1 4
D~sposition: Coordlnared w ~ t hAPO
L

TRACKING INFORlMATION (FEMA U ~ ONLY)


E .' $'2, ?'<* c p .
%< , *l

NEMlS 'Cask ID /f&?, FWs/


Actlon Request # Recelved by (Name and Organization).
Program Code/Event #. State: I~ate/~im
Submitted.
e 1 Orig~natedas verbal
u,. ,.,. r
I
I
I
t1. Who is Requesting Assistance? (Cornplatedby Requestor)

Pcrmuncnt Phone:
Reqttclurstor Organization:GF#3
11. Requested Assistance (Completed by Requestor)
Descrtption of Assistance Requested:
ACTION REQUEST FORM

ENGINEERING & CONSTRUCTION SUPPORT FOR DEMORT (Federal Operations Support) - 1603-DR-LA-COE-MVD-
19
FAX#:
E mail:
- (Interim draft as of 1/03)

U SeeAnached
1

~mc.ndrnrnt/Vf(foinrrpaw ly
02-

-
Quantity. , Priority: i ~esavtng a 2 We sustaining Date/Tirnc Nccdcd:
3 Hfgh 0 4Me~km 0 5 krml 9/7/2005
I I P I I V P ~ ~~ ~&tF g
an:
=
-

-
itc POC. Mickey Fountain 24 Hour Phone: PAX # 4 1 1 1 ~
State Approving Ollici~lsignaturt:

-
Datc:
I
I 1111. Sqwcing the Reguest Review/~ordiaation(Operations Section Only) I
6 s RRl!ew by: f d . 5 ~ ~ - [Ioo~tlons nPf~x~Smlmt

0 WR-JW o m (explan) meraeenn Agreement


Other Coordrna~onby. Rauis~Urns Missloo Mgnrnent
O other Coorbination by:
Omer Cmrdmatlon by
Immediate Action Roquircd: U Yes No Action request EK#:
Dnre/Tirne Assigned: ass~gnedlo: 0 Mher:

N:Statement of Work (Operations Section Only)


O F A Aclion Officor: 24 hour Phone: FAX#
I X M A Project Oflicxr: 24 hour Phone: FAX#
Justificatiot~/ Staternent of Work:

Estimated Completion Date: ( coat %innate:


V. Action Taken (OperationsSection Only)
0 Accepted Rejected 1
0 Wrtabie Property

I
Disposition: Cwrdinatcd 161th A M )

Actlor1 Rcqurst b
Program Code/ P;vent #: /state: I ~ a t e / ~ t mSubmitted:
e 10 OrQlnated as verbal
>

ARF # 1, 10,000,000
-
--
ACTION REQUEST M)RW 'Q [ '/-k~nterim draft as of 1/03)
'I. Who is Requesting ~ssistance?(Completedby Requestor)
liequcstor Name/Tirlc/Slate: Mickey Fountan, Team Leader, LA Tmporaly PhoneJFax #:

Permanent Phone: FAX #:

Requestor Organization: ESFW E-mail:


11. Requested Assistance (Completed by Requestor)
Dcscnption of Assistance Icequestcd: $200,M30,~0.00
Enginrer~ngIk construction support to provide, construct and/or repair crit~calpublic facilittes to include education, judicial, law
enforccrnent, (ire, b~lleting,corrrctional, governmental and other Facilities as directed by FEMA. (Federd Operations Support)

-
Quentitv: Priority: C] 1w e ~ v i n g 2 Ltfe susta~rung Date/T~meNeeded:
3 High 4 bfedium 5 Normal 9/7/2005
Deliver): Sttr Locatton.

-- --
Site POC: Micks~ountain 24 Hour Pho

Slate Approving Official signature: -


-
C(

Date:
-.

-
'

a
P s

L O Review
~
~

by:
~ e -
111. Sourcing the Request Review/ Coordination (Operations Section only)
~ : - - C]tmnattoos
a Other (explan)
Procurement

C] Interagency Agreement
Other Cowdfnation by. Requisitions C] Missrtm Aacgnment
Other Coordinabon by:
other COOrdl~liOnby:
lrnrncdlatc Action Requtred: 0 Yes fl No Action request D ESF C:
DareJTime Assigned: assigned to: W:
IW Statement of Work (Operations Section Only)
OFA Act~onOfficer: 24 hour Phone: FAX#
PKMA Project Otiicer. 24 hour Phone: FAX#
Justlficsltion / Statement of Work.

b:st~maLetlCornplet~onDatc. ( Cost Estimate:


V. Action Taken (Operations Section Only)
Accepted 0 Rejected Accountable Property
Dlsposltlon Cwrdlnntcd ulth APO
+\c~Q 3 -DR-LA-COE
MA
\L~\~D-z\
-
TRACKING IMFOR~~~ATLOB
., <
(FEU USE
NEMlS Task ID. #(#o?, 33d&8 -
Actlon Kequesr # /~ecelvedhy (Name and Organlzatlon):
Program Code/Event 9. I~tate:
~ a t c / ~ l r nSubmitted:
e 1 I
A r ' - _,.a ,
Or~glnatedas v~rtmt
ACTION REQUEST FORM &D- 0%

ROC EST

-L
-.- -

Wler Coordination by:


Other Coordination by:

OFA Action Officee 124 h o u r Phone/Fax #s:


FEMA Project Officer: 124 h o u r Phone/Fax #s:
Justification / Statement of Work:

IV. Action Taken (FEMA USE ONLY)


Action Mututal Aid Donations Requisition 0 Pmcurement lnteragenc~Agreement a Mission Assignment 0 Other (describe)
Request ( ~ c q form
- ~

-
(FF 60-1 (FF 40-1 attached) (FF 40-3 attached) (attach AKF to MA)
Results: attached) attached)

Disposition:

NEMIS, Task ID:


-6a 5 -& s+@ Estimated completion date: Cost estimate:
q/,o/oc 1753 Accountable Propetty
Coordinated with APO

TRACKING INFORMATION (FEMA USE ONLY)


Action R e q u e s t # I~eceivedby (Name and Organization):
Program Code/Event #: State: I ~ a t e / ~ i mSubmitted:
e IC ] Originated as verbal
C

ARF-Barksdale Fed Ops support 9-10-05


ACTION REQUEST FORM
dm- 037
I. Who is Requesting Assistance? (Completed by Requestor)
Requestor Name/Title/State: Drew Benziger Water A0 ESF#3 IT- - TV Phone/Fax #:
- -
Permanent Phone/Fax #: -fax E-mail: 6 - nil
Requestor /
Organization:
[7 State
/
./', E ~ C a ROC C] EST ERT-A ERTiDFO OFA Other

11. What ~ e e d Done?


d (Completed by Requestor) 0 see Attached .
Description of Assistance Requested:
Dispatch 1 truck of bottled water and 1 truck of MRE to Port Allen Lock (2 101 Ernest Wilson Dr. PO^ Allen, La ) in support of Fed
Ops for on site personnel consumption. USACE DTOS

I ~ u a n t i t ~2: trucks ice J ~ r i o r i t ~ : D 1~ i f w v i n g 2 Ufe sustaining I~ate/~im


Needed:
e I
1 I
1 truck water a 3 High 4 Medium 5 Normal
I
-Port AUen Lock
-
-.- 2101 Ernest Wilson Dr. - Port Allen JA.
Site POC: Dave ~ o l l e j f 24 Hour Phone/Fax #s:
State Approving Official signature:
-
- Date: 91 10/2005
I
4

111. Action Request Review/Coordination (FEMAUSE ONLY)


-pt Reason Rejected: Review by:
C] Reject 0 Cog Review by:
Other Coord~nationby:

l ~ c t i o nrequest E g #: 1Date/Tirne Assigned:


I Other Coord~nabionby:

Other Coordination by:


l~mrnediateAction Required: 0 Yes 0 No
I assigned to: Other: 1 1
C] Tasking Under Existing MA # Short Description of MA:
\
OFA Action Officer: 24 hour Phone/Fax #s:
FEMA Project Officer: 2 4 hour Phone/Fax #s:
Justification / Statement of Work:

L
IV. A c t i o n Taken (FEMAUSE ONLY)
Action 10 MuWtal nid lo Donations lo Requisition 1 Procurement 1 tnteragency Agreement b MBsion e i g n m e n t l Other (dexnbe)
Request
Results:
1Rcc1-A form
attached)
(FF 60- 1
attached)
(FF 40- 1 attached) (FF40-3 attached) (attach ARF l a MA)
I
---

NEMIS Task ID:

TRACKING INFORMATION (FEMA U S E ONLY)


Estimated completion date: Cost estimate: 0 Accountable Property
Coordinated with APO
I
Action Request # l~eceivedby (Name and Organization):
Program Code/Event #: State. I ~ a t e / ~ ~ Submitted:
rne ( 0 Onglnated as verbal

ARF-Port Allen Lock Fed O p s support 9-10-05


7 ~ F o3 -7

-
ACTION REQUEST FORM (Interim draft as of 1/02
/

, Who is Requesting Assistance? (Completedby Requestor)

Permanent Phone: FAX #:


Requestor Organization: ESF#3 E-mail:
11. Requested Assistance (Completed by Requestor) see ~aached
Description of Assistance Requested:

I
ENGINEERING & CONSTRUCTION SUPPORT FOR DEMORT (Federal Operations Support) - 16OkDR-LA-COE-MVD-19
Amendment 02 to increase by $20,000,000 total of $31M.

Quantity: Pnonty: • 1 LifesaVlng 2 Ufe sustaining Date/T~meNeeded


I
3 3 Hlgh 4 Medlurn 5 Normal 9/13/20C
Dellvery S ~ t eLocation.

. - -- --
-

Slte POC: M i d t e Fountan 24 Hour Phone: .-.' FAX #

State Approving 0fficla.l signature:


-
-- Date:

111. Sourcing the Request - Review/Coordination (Operations Section only)


0 OPS Review by. Donattons Procurement
0 ~ o Revlew
g by 0Other (expla~n) 0 Interagency Agreement
0 Other Coordinat~onby 0Requlsltlons 0Mtss~onAsszgnment
0 Other Coordrnabon by
Other Coordinat~onby.

Immediate Actlon Required: fl yes 0 No Action request 0 ESF #:


Date/T~meAssigned ass~gnedto. 0 Other

IV: Statement of Work (Operations Section Only)


OFA Action Officer. 24 hour Phone:

Estimated Completion Date: Cost Estimate:


V. Action Taken (Operations Section Only)
Accepted Relected lo Accountable Property

Coordinated with APO

T&CX:NG I X ~ R \ : A X O N [FEMA U S ~ O @ . Y ~ L
, .be , -,T +* 5pt &*+a+ cf h+:*+4.-- *,-* ., . %a@ < 2 9 2
N E M I S Task ID: /5&9, yWs/ L #
Action Request # Received by (Name and Organization]:
Program Code/Event # - State. Date/T~meSubmitted: I Origtnated as verbal

AKF #Z Z V UUV UUU


7 3 9
mc 'Dn-*&
(Interim draft as of 1/03)
I. Who is Requesting Assistance? (Completed by Requestor)
Requestor Narne/Title/State: m/kl/ PC~IMI~&~PX/ Phone/
1
- -Phone: - FAX
-
Requestor Organizabon: 6 ? ~0~ 6
d f l@d'6~6~zE-md:
I3. Requested Assistance (Completed by Requestor) [3 see Attached

-
Description of Assistance Requested: Svtf 0- (GJ 6&&-?.1/G
TQ $UP- d n w &M&C/J~(G~$(&&~U.
ufb u M em Mb ~9-L WLA~C ~~NS~,
>€@?,~W~ST&RM~'.CZ. 1)-
j,,91f
E I G I Z Se~ ;r zs uW, N W ~ IV 46 ~ Z O J ~ O W -ZPI-J -wnf;qu&~ a h
hlorlty: 1Mesaving 2 Ufe sustain~ng Date/Time Needed:
f%(YW *=E:@ 6 e 4 3 H~gh 4 Medlum 5 Normal T[?/DS'
Dehvery S~teLocabon: q4h~Wo
/trv,i//dL 1fcL '*KT ,Jrl86d. PkiQG / ~ ~ f # f & &

0 Interagency Agreement
10 Other Coordination by:
Other Coordination
Oiher Coordination
-_ - .- -A

FCP..,~
[3 Mission Assignment
I
Immediate Action Gqu&
- Dco Action request €SF #:
Date/Time Assigned: assimrd to: [3 Other:
:
'IV:Statement of Work (Operations Section Only)
OFA Action Officer: FAX#
FEMA Project Officer: 24 hour Phone: FAX#
Justification / Statement of Work:

t
Estimated Completion Date: I Cost Estimate:
V. Action Taken (operations Section Only)
0Accepted Rejeded 1
0 Accountable Pmperty
Dispos~tion: Cmrd~natedwith APO

Action Request # l~eceivedby (Name and Organizabon):


Program CodelEvent #: /state: I ~ a t e / ~ i mSubmitted:
e 10 Orcg~natedas verbal
ARF 1-03
l~eceivedby (Name and Organization):

ARF - Tent
(~atef~im e
SubmiW.
-
(0orlgimtcdaswta~
AFo *b
)ACTION REQUEST F O W (Interim draft as of 6 / 0 2 )

11. Who is Requesting Assistance? (Completed by Requestor) I


IRcquestoraName/TiUe/State:
A ..
&#L.TE/ GOOAF'SF-~ LO& Temporary PhoneIFax #: I
Permanent Phone: FIU( If:- e

Requestor Organization: USACE g g f - 3 E-mai1:t- - . .


w
-
-1J
11. Requested Assistance (Completed by Requestor) see ~ttached

IDescnption of Assistance Requested:


,rt~ r o ~ pB N ~ J
C D~+ .~. A N ~b / h N h h i o
F ~ ~ J ~ u L Q
.
ilppp+ I
4h3 / u c P L ~ ,Q~ d~ f ' - J - J O / ~

Quantlty: cr)50
see abo ve
P O : #- bfe sustalntng
a s N-I
DateITime Needed:

Delivery Site Location:

--. -=- p o A
-
- -.c U%c6 - JAM ' .

s i t e POC. RL we h ~ I V 9 " I -
- f
State Approv~ngOffic~alsignature: - Date:

111. Sourcing the Request - Review/Coordination (Operations Section Only)


0 OPS Rewew by: IGO~nations [7 Procurement
Log Review by: 0Other (explain) Interagency Agreement
Other Coordination by: a Requisitions C ] Mission Assignment
Other Cmrdination by:
Other Coordination by:

Immediate Action Required: I-) yes a No Action request


DateITirne Assigned: / assigned to: 0 Other:

W Statement of Work (Operations Section Only)


OFA Action Officer: 24 hour Phone: FAX#
FEMA Project Officer: 24 hour Phone: FAX#
Justification / Statement of Work:

Estimated Completion Date: Cost Estimate:


V. Action Taken lonerations Section Onlvl
C]Accepted Rejected
Disposition: Coord~natcdwth APO

L____1
INEMIS Task ID:
--
1
I - , --: ... 9 ,.....,,,.
. .*Y It?.::,, ;..-: .I . .,.:. -.-? p -.... .-..I ..-3. I
Program Code/ Event #: (state: )Date/Tirne Submitted: 1 3 Originated as verbal

Blank A R F . x l s
- - --
ACTION REQUEST FORM

-
~ M NO. E 1660-0047
E u p r ( c s November 30,2007 I

I. Who is Requesting Assistance? (Completed by Requestor)

FAX#:
Ef- 3 -1
I I I t A
-
Reauestor Or~anizahon: - E-mail:
V
11. Requested Assistance (Completed by Requestor) see Attached
I
IDescription of Assistance Requested:
A~UFT fie%E& 6 CCPklw d ~ n ~ w
t fe+ 7 C h ? u w ~

Quantity: Priority: I Lifesaving z~ f sustaining


e Date/Time Needed:
3 nigh 4 Medium 5 Normal r SEW OF-//
OW

I
Delivery Site Location+
Vu ?m&i-- -. -:- -
-
' 8
M ~ L w ~ ~ ~ c s T B O * ~Z q " ~ 8 80
3 0 " 81 ' 0 3 d
l ~ i t ePOC: 24 Hour Phone: -
-
- FAX # 1
[State Approving Official signature: Date:

111. Sourcing the Request - Review/Coordination (Operations Section Only)


@ OPS Review by: -#-{A- y
& 1 tIon*ns C] Procurement
Log Review by: Other (explain) Interagency Agreement
Other Coordination by: Requisitions Mission Assignment
Other Coordination by:
Other Caordioatlon by:

Immediate Action Required: U yes C] No Action request ESF #: /


Date/Time Assigned: I assigned to: Other:

IV: Statement of work (operations Section Only)


OFA Action Officer: 24 hour Phone: FAX#
FEMA Project Officer: 24 hour Phone: FAX#
Justification / Statement of Work:

a s a h ' a r r ~ d $ QWMW W C I ~ % ~ ~ M P Sue


$ 4
69*7-S

Estimated Completion Date: I Cost Estimate:


V. Action Taken (Operations Section Only)
Accepted Rejected 10 Accountable Property

Action Request (t IRccelved by (Name and Organization):


Program CodeIEvent #: /state: (~atel~irn e
Submitted: I Originated as verbal

FEMA Form 90-136.NOV 04


JCo 6t9 -

OMB No. 1660-0047


Expries Nowmber 3 4 2007
I. A Who is Requesting Assistance? (Completed by Requestor)
Requestor Name/Title/State: 6&/ 9 &/&&/L Temporary Phone/Fax

Permanent Phon -
FAX#: ".?

Requestor Organization: . E-mail:


11. Requested Assistance (completedb y Requestor) - ~ee~ttached

Quantity: Pnorit~: i ufesaving @ 2 Ufe sustaining Date/Time Needed:


3 Hgh 4 ~edlurn 5 Normal 22 g&ppfF

lstate Approving Official signature: Date: I


111. Sourcing the Request - Review/Coordination (Operations Section Only)
OPS Review by: Donations ~marrement
- - -
lo U Log Review by:
Other Cowdinatton by:
Other (exqlain)
RequWtians
UInteragency Agreement
Mission Assignment

'0
Other Cowdlnation by:
Other Coordination by:
Immediate Action Required: U yes 0 No Action request ESF #:

I
Date/Time Assigned:
9 /a~IOS ass~gnedto: Other:

N: Statement of Work (Operations Section Only)


OFA Action Officer: 24 hour Phone: FAX#
FEMA Project Officer: 24 hour Phone: FAX#

Estimated Completion Date: Cost Estimate:


V. Action Taken (Operations Section Only)
0Accepted Rejected 1CJ Accountable Property
Disposition: I Coordinated with AW

--.--- --- - --- - .- -- -


Action Request # l~eceivedby (Name and Organization):
Program Code/ Event #: !state: IDate/Time Submitted: I Originated as verbal
-
FEMA Form 90- 136. NOV 04
Permanent phone:- A FAX #: n
I

Quan tlty: 2 Ufe sustaining


4 Medium 5 Normal
Delivery Site L o ~ a s o F
-
-C

24 Hour Phone:
- -FAX#
-

State Approving Olfic~alsignature: Date:

111. Sourcing the Request Review/Coordination (Operations Section Only)


OPS Review by: Dmatlons C] Prprement
1
0 Log Review by: / / Other (explain) Interagency Agreement
0 other Coordmat~onby: 0Requlsfflons Mlsgon Assignment
Other Coordlnabon by:
Other Coord~natlonby:

Irnrned~ateAchon Required: U Yes No Achon request ESF t:


Date/Tlme Assigned: assigned to: Ofher:

IV: Statement of Work (Operations Section Only)


OFA Action Officer: 24 hour Phone: FAX#
FEMA Project Officer: 24 hour Phone: FAX#
Justlflcatlon / Statement of Work:

Estimated Completion Date: I Cost Estimate:


V. Action Taken (Operations Section Only)
Accepted Rejected 0 Accountable Property
Disposition: Coordinated with APO

- . .
-. - - -
Action Request # Received by (Name and Organization):
Program Code/Even t #:
-FEMA Form 90-136, State: ( ~ a t e / ~ i rSubmitted:
ne - I Originated as verbal

NOV 04
.. 1 . U.S. Departmentof Hometand Security I I OM6 No. 1660.0047 I
Federa!Ernergency Management Agency See Reverse for Expires November 30.2007
Papennork Disdosure
ACTION REQUEST Notice
I. REQUESTINGASSISTANCE (To be completed by Requestor)
-questor's Name (Please Print) Steve Philben 2. Title ESF #3 Team Leader 3. Phone N ,(.. ,
'

uestofs Organr'nation USACE ESF#3 ail Address esfesfO3@dhs gov

II. Requested Assistance (Completes Dy nqu--r) % I


1. Descripttonof RequestedAssistance:

I
k r e a s e NationalActivation Mission 1604-DRMS-MVD-14 by $500,000for Technical lnfrastnrdura advice and assistance to ESF#3 elements.
C~mulativemission total will be $3,500,000.
- -
Action Request No. 1!50$33001
I

Originated as verbal

IFEMA Form 90-136. NOV 04 (This particular form hasI been updated for compatibility with
I
DART)
I
- -
i ACTION REQUEST FORM (interim draft am of 1/03)

Trmmraty -o
P
h -

FAX #:
ESF 113
II. Requested Assistance (Completed by Requestor) 0 see~mrdrd
Description of Adstance Requested. -
National Activation (FOS)- $1,000,000

Quantity Rj0l-W IWesvlnp 0 ZUcmst¶bw DatciTime Nccdtd. .


El 3~ 4~edbm SNad

Delivay Site Location: _

Site POC.
--- -- - .- --. . .... . . -. - --- -. - -- .-
24 Hour Phone:
-.. .- . .. . - ..--.
~- &- i
-
.

Date:
II
- ordination (Operations 8ection Only)
0oclla-U OPmammt

*
Lag-by: 0 - c ~ ) 13-4V-t
0 :yb- ORewkR- 0-kslaman
1-' other-by:
-bv:
e&te Rtquind: U ye No Auionrcquest 0
DatefTkne Assigned: I assignedto: (wler:

IV. Statement of Work (Operations Section Only)


OFA Action Officer 24 hour Phone: FAX#
FENLA Raject Officer: 24 hour Phone: FAX#
Justification / Statement of Work:

Estimated Completion Date: I coat m a t e : me LwK

V. Action Taken (Operations Section Only) \''


o~rapted 0W-d a -RopertV
Disposition: cmwdinated w i t h AW

by (Nameand Organization):
/ ~ a t e / ~ i mSubmitted:
e
1. Who is Requesting Assistance? (Completed by Request03
I I
wt
s t
o l -ti0 ESF 3 - - '--
[I. Requested Assistance [Completed by Requestor) - =!I S c c ~

site POC: 24 Hour Phone: F& #


+

3tate Approviae Of6icial Bignature: Date:


rdination (Operations Section Only)
0c)ONmm O~mranact

rJ-(-l orc
b
laaecncv-
Cl~cslllswom

Actionresuea eat:

tW Statement of Work (OperationsSection Only)


FA HOP 0mcs: flirkg /$&/L/eNIU 24 hour phone: FAX#
I
?ErdAPrsjectOf[im: 24 hour %one: FAX#
luati6cation / Statement of Work

Date:
%timated ~ o m p l e t i m 30 Jefl J cost ~stimate:
A/
4 ri, -
V'. Action Taken (Operations ~ C c t i o nOnly)
I

O~cnpbd ORcmed D -Pllcpdl


Lhpoaition: ~ t a l * A m

Date/Time Submitted:
I

usmt Phone: -
ESF 113
quested Assistance (Completed by Requestor)

-
FAX w:
!L

I
,
NationalActivation (FOS) $1,000,000

-ti* Riority: 01 0 2urcrvswJno


8 3tm 0 4- 5-

Dclioay Site tocation:

- --- I
-.
.-- :=.. ..-.-
- --
I-
.. ..- ---.
----.- - -_ -.. _-. -_. _ _
..__ - ,

site POC: '


. 24 Hour Phone: F ; ~ U .
. . .
I

-
-
-
Date
ation (Operation8 Section Only) - -
Ooonamr Olwnmm#
Doma(-) D-~gaana*
0 othrcwcaulrarbl: Owwbm o-kslpm#rt
"--bl:
laacoaaMaacbl:
~&onRcquired: u ye 0 NO Actionmqucst a ffr:
assigned to: 0 Oms:

OFA Action OBcer: 24 haut Phone: FAX#


FEMA Project Ofiica: 24 hour Phone: FAX#
Justification / Statement ofWork:

. .

PMhated Completion Date: I Coat ~stimate:


\
I. Action Taken fOperatfons Section Only) \
!'
J ~ e e e a d O~tleched
~positian: ~gdrithAF0

- .. .
. 'JY/0?/2005 0 4 2 6 F A "
" ?C .. M 002/003
1 - t

oa/os/2aoe a2:47 F A X
I
226 alG 7 6 0 1 LRL~EP riB 0 0 2
- E X ~ oJ 17% f f ~ t " a ~ ~D. o/ ff i fe/ OP-!f-y 323-
I
1 ACTION REQUEST FO& ODPI NO. A tu0.004 7
RxprGrs R d r SO, 2007
I. Who i s Reqrrssltirrg ~ s a i s t s b c c ? (Cosrpleted by Rcqucstor]
Rcqncalor Nnmc/T1tJe/$.~ucc: --.- l'cmportuy Fhonc/f k: -
Pcrmnncnc Phono; F, fi ,'W o e ( r , &L,IC*O
fin/ oJ
S C C U I I ~ ~ ~ I .
wo
Requestor Orgm17su'on: t-md:
11. R o q u a ~ t e dAoaint&tnce (Cornglotcd by Raqucrztor[ CJ %js*rn*w '
beoerintioo of A = a i s t n * r ~ l <~~ucrr@#~ma*,~~~- 6 %I-SrUICE A J I J ) fl- e g
3t G. " 8-7 " bJ 13.9 4) ~ G F A T( 03 1 7 sf-
, y,~@) fc,,~co CL) IY, W
%?,a&

-
fld ?do /+-G N II'L &JwI~~ AI *41l
w ~h~rtlJE : ~ 4 3J V Gw
UPS. i-J m y > \ ~4 (?T,SC-~GC+L .- V+G+
d~4-0*F 'hvldk ~4;n-i OWO
Qu*olix>r. -1,I
0 r urr~rlng C1 z utc ~ ~ ~ I r h l n p Dnrc/l'rrnc pcozdccl:
- -C Priority:
!2 3% n 3 nd~urn s Norrn#l 17sep 1-0 l ~ e ~
~clircr;r.si==k c a t i o n . ~ 1 - L P MI':~ , LA -)~mP\l
3~ 7 ~,e
<- 14.rt-
k f i 4 m . %W TZ+$sf@-T&Q
- 15- l m .

JII,,Yourcing the Rcquenr; R-&cw/~oordhmtfon (Opcratlons Section Only)


74k- ZW;,',IqP
L-W 0n""c.nwM
0 100 R W ~ W
W:, lJ mt~ (MOD) a ~ ~ ~ M I Q I~Wr q ~ m c r ~
0tb.r c'mnJnchsn by. 0 scqtalmns UW- w e n t
0 oOIW Wrdhuim b v
a OVI.rCmmhcynhl:
-Acuon -
lrnrncdracc: A c k n P ~ ~ u i r c d ;0 yo% 1-J NO rcquesl 0 rsv 8:

Darc/Tirnc Asrdignacl: assiped to: C] OW:


1V: Statement of W o r k fOpcrnUon6 Bcotlon Only)
+
OFA Action Officer: 24 1iot11'Phonc:
FEMA Projcct Otfjccr:
J t ~ o c i T , ~ : ~ l r i o/nEtat*rnurt 01 Work:
24 hour Phone: -
/t
I p5Sw4 15 k s Q C 5 J% e 4 m LW (A\/,-(6S(tEt7t~S

c C M S / N E M I S Task ID:
Actkn H c q u v a ~II
---.-
(~ccoivadby ((Nnm2,.%~d0r~nvsi:ntion):
-
Prap.ar-r)Codc/Evtnr #: [s~sL~: Dnte/'I'irnr: Subnrilccd: Ia ocDhBtjzJ
-rr.vrmal
'J
FEMA Fur- 90-146, NOV 04
- / ! I I 2 I 1 . . 2 2 5 9 2 5 '7501 LIii.SI!l'
l.4 0 0 2 / 0 0 2
f. I

1 ACTION REQUEST F O W o m NO. 1660-004 7


Expr-ies November 30,2007
I. W h o is Requesting Assistance? {Completed by Requestor)
i
Temporary Phone/Fax #.I - -- . --
I

Pel.mancnt Phone: FAX #:

Request01 Organlzatlon: &


J&
,, Oc)eQda Qc E-mall:
11. Requested Assistance (Completed by Requestor) 3 see Attached
Drscnptlon of A s s ~ s t a n c eReqursted.

Quantltv Plborlt)'. 0 1 Ltfesavrng El 2 w e SURalnlng Date/Tlrne Needed'


- &!G 3 Hgh 3 4 Med~um 0 5 Normal
Del~veqrS ~ t eLoc_a11513
orIa4 ?D to puky -4 -hVcH a c . r l . 3 con-+)**
Cafi\t;r
~ ~ POC:
t c r-h,cJ r/\ o , \ ~aw 24 Hour Phone.
\
State Approving Ofiicial signature: Date:

111. Sourcing the Requpt - Review/Coordination (Operations Section Only)


Donations 3 ?b ocurenent
C Other (explain] Interagency AQreeolent
Cj OLher Coordination b y

0 Other Coordination by:

[7 Other C~ocdinah'ot~
by.

Immediate Action Required: U Yes G No Action request 0 E5F #:


Dnte/Tirnc Assigned: I assigned to: C] Other:

IV: Statement of Work (Operations Section Only]


OFA Actior~Oificer: 24 hour Phone: FAX#
FEMA Pi-oiect Officer: 24 hour Phone: FAX# e
L

. J u s t i f i c a ~ ~ o/ nStatement ofWor]c:
I

-Ta SS~\+W e-3.r.l ee,peac. g e c % P n ~ . I

Estimated Calnpletion Date: I Cost Estimate: ~m


V., Action Taken (Operations Section Only)
AccepteA 0Rejected 10 Accountable Property

eCAPS/NEMIS Task ID:


Hct~oriRequest f Received by (Xame and O~.g~~rlizatlon):
Program CodejEvent #: State: I ~ a t e / ~ i mSubmrtted:
e 10 Originated as verbal

FEMA Form 90-136,NOV 04


- . r ACTION FUCQ'UEST FORM ~ 1titi0.0047
W I LNO.
I"xprAicsNovon~hnr30. 2007
1- W h o IS Requcslrlg Assistance? (Complctcd by Rcqucstor)
..
FiY., r> ->:.,+. --,
p,
..7 ,--)

I~(:~LI~.!S~I.I~. -.
N:~~~IC/'I'~I.~~:/::I~~,I,!:<]//~ .-sr.n.g <./I t .f C I I I ~ ~ I . ~13'
%

-
~ I 'hnn~:/I.':Ix I::

!:'ill ~ l l ; > t l r r i lP h o ~ l t : :
-,- -- ITAX N-:
-- -
I~t:qkl(!?.lc.~r i,-11 ?.;I t\ixi\(irn>: /VLJ ,-A
'"
,.- <..- .f-::;2 .-..w,.<.,.,<,. k:.-...J-::t--- S~-hl,:liI:
11. Rcqucstcd Assistance {Completed by kequestor) Attarllcd
cdrt= '

I
p-

(,'ht:~~~t.ity: l ~ " r i c ~ y;
~-if [':l J wc~vi,l14 U 7. ~.ilcswuarm(l 'I~):ILC/'I'~~I~~: ~t:(:rlc~l:
- -42-. 1.,1 .I Il!;lt , [:'I .I t-lcdi8.11at
L:l 3 ~Ic~I~II~II

--
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--- ---
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i I ' ckL_# .<: 7.4 lluut I"holic: -.Mi- -= IFAX #

SI:~III! A~OIIIV~JI~. OI~II-~:.I~ 1 ):)I I::

111. Sourcing the ~ e ~ u . y t &Review


- / Coordination (Operations Scction Only)
',
1-tj.4:;
ltcvipw 1 ) ~ :
- ;
-
& ,-._ J ' I...' 7 n ~rrril~?uls U~,nc.lrrc~tteca
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1
('\ ---------I

r.'.J ~TIIG~. (I~I$;I~II) U lnte~.tyr:f~ry


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[:I] 0IJ1~~1(:ootdi~6.ilc:nn hy: -.
-.- U~eclc~ii~tio~r; !,:'I t-ih-iuiAlpqnmanr
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ltim~
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I
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yl.?;

I ):.II~:/I'/IIIP y ,. $, .0 ,=rA:<:;ii;~ic-d: ;~%sif:r~(;cl !,I: 1 .I C1111t:r:

IV: Statement of Work (Operations Section Only)

-0 l ; A A c I i t ~ r t<)fficc,.:

Ia'li;MA IJr'c~jt.t:L OlIiccl':


24 Iloul- P!torie:
24 h a u t P l ~ t . ~ l \ c :
IZAXII
FAXp
, l ~ t : : ~ i J ' i ~ : ~/ ~~~~~I.c:II~cII~
li~~~~ ol'tV~~c.lc:

-
E:;I IIII~IIVI
( , ~ ~ ~ c ~ i pJ>nle:
lc~.i~~~i 1 Cusl~?itinmt.c:
V. Action Tuken (Operations Scction Only)
1-'I fil~.c1act.l r:l RC,C~J.~:,I AI.LI:I?II~AIIP I.IO~ICII~

Ltisp~,t%i
rior~: c:nm.~lt~~:,terlw i l l # A H )

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-- 7-nslc I I 1:
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W h o is Requesting Assistance? (Completed by Requestor)


ACTION REQUEST FORM 0428 No. 1660-0047
lkprfra N o w m L w r 30.9007
,.r(-;
- {-) (2;5 3 :
r >

I'ctnpornry Phone/ Fax It:

Kcqtrestor Orguniurt~on: E-inail:


XI. Requested Assistance (Completedby Requestor) •
Description of Asuistancc Rcquesterl:

Quiln~~cy: , - Ipriority: I ~~f~~~~~~~ U z bfc ~ , 5 u m m g ~ ~ a ~ e l ~ rNeeded:


irnc

-
ice poC: :js.,i,,::(

S b t c Approving Ofiichl sigi~ature:


+-,L:
!
;g:\i;,,$;.$<siC&.+--! s.;t-A,b;':-$.
;i: :,,;(::
:.
-,
24 Hour
/
,
I

Cc/
. --_ H
4

Dote: 7/7/51
/

111. Sourcing the Request


k
- Rcviaw/Coordination(Operations Section O d y ) I

,,a wi~iewtw: A%,~Ati-?/:k


+
JC?..~~ .L-. Q ~ooatbnr ~mxumnwnt
Log RwiCw by: 4
0 0Iher Iexpl~htl 0 1nteraga"cy ~precmcnt
0 t h Cwrdlratim
~~ bC. a R~?qukjUans I3MWw Asslptmnt
0 Other Coardlmtlonby:
0 Other CbordCuUm by:

lmrncdia tc Acbon Requrrcd: wy~s Action request ESF #:


Dute/Time Asl~igned: assigned to: War: L - 4 6 - - - -
IV: Statement of Work (OperationsScctfon Only)
Ol:A Action Oficcr: 24 hour R~ane: FAX#
FEMA Project O[ficer: 24 11uurPllonc: FnX#
Justiliation / Smtcmncnt of Work:

Esticnatcd Completion Once: Covr E ~ ~ i m a t c :


V. Action Taken (operations Section Only]
OACU'OW URejecd ~ccwnbalePt~l)enY
Uiaposition; Ctmrdinnred with An>

rp~c~xrvd
WPORMATXON USE..ONLYI:::?'.$+;;: i!;.;;:;:.
.;, ; .,:', . :.: 3';:+.'s .. . ; .-
'. . .
.- : . :.: ... -.. ; ;
. . . . .. . .
z ... .
.._I . L
.

.CAPS/NEMlS 'fnsk ID:


d o n Recluest /t [~cceivedby (Name and Or~ar~izatianl.:

EMA Form 90-136,ROV 04 .


* .,
ACTION REQUEST FORM OMU NO. l ( i ( ; 0 - 0 0 4 7
? r 2007
E v p f l a s N o ~ ~ r n & <30,
I. Who Is Requesting Assistance? (Completed by Requestor) ;:-:,, <:
,-:/-.
1.
,-);;;. :: ...' (
. ..\.-. (;?

: : I : : t ~ ~ . orleans
.
.
:
-

Q
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.l.t:r~ir,>or;tr\. I;*\~II~.I~:/ 11:

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-. w.
-
I?VI.JI.~(.::SL,,)K(.:)I-?.:II)IZ::II~OII: E-~iiall:

11. Ruq,uested Assistnncc (Completed by Raquestor] i-.. j. QY.: AIt.lSt~ed


i~~::.x:riptii:~rl Of I\:.:-i:<l:irti:.(: ~<l:~~lli!:;l~?~:i:
[;as t o u e ~ e d - ~ o C f o& + ~ q n s y ) & r f/: ~e f i 3 A i ~ l s4 c a b r ( &
j f ~ ~ Vf Y xI C ~ ~ C
h e sL3;nga r c . ~ r ,sf Z r p k y c F;eld.
()u:.lt~llly; I'I.IIII.I~~: (-1;I I.~U:;IV~I~~~ r].! \.it,? 5*~a;ti~~;~~g I..~:II(.-/'~'~ILIP Nc~c[t:rl:
lrg $
J II~,,II 1-1.I~I~~.II,~UI .. C s Nort~,,~l
L l c I ~ v :;;I?
~ y I ,I.I~:cI~IV~:-
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.&

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,,--z-6m0

:;I;I~(: A r ) f ) r ~ ~ v i n(.')l'i~ci;:ti
g :;ip,rj<i~~~rt::

111. Sourcing the Request


,"
- ~ckiearj~oordinntion(Operutions Section Only)
,/ :.,;I j .LC>
h%01'S Rc.vlc:vbl.:~ b,,; ,/?i!,,
." , ..&I ~5-7 I-! hation.: !.I-] I J C ~ ~ I I I CISOI:II.
-
c; t . 0 ~~cvir?w
t~y: / 1. ] (>tt\or (rtsplain) u tl~ts:# ;t(ronc.y :y:~lc~!ntc:r,i
Ilj O U I ~courc11rt~3on
~ hy: 0~q\dgtior~<, I."-jfii.,*;irJll As>ignmenr.
n CMltcr Cmrdtnanon w :
n C l t h ~C~j
~ .r..tdll.llo, ily:

Ilnmedi;ltc: Acli1~11Hc.quit.ctl: A! Yes . (""1 NO Ar:l.lncl r r . q t ~ r s t U E5F r :

l>;:~rc:/'l'irr~c :I>;:;igi1~~11: xssif:ncrl TI?: U ~ n w :

IV: Statcmcnt of Work (Operations Section Only)


i.jPl\ Acriork 0il'ic:ur.: 24 tltrctr ltha\le: VAXit
F I T M A Pr,(-,jcc~C)~T;C~:~.: 24 II<I~II.
Ph(111c: l:~Ni?
/ SLi~i.cnrCri
'lu;;t ilic.:cct.it.~~~ I. OI
Wc.)rIc:

1S:~ilrrl:itc;d C n ~ ~ ~ [ : d t ~ .r)cttt::
r
iclr~ I C:USL E:~L~III:II~;
V. Action Taken (Operations Section Only)
nArr~~,tt=n ij~<cjci:tctl /I-.! :ytrournat,~cPtapcctv

~ ~- .

-
~ t : q ~ j c : i ~;I
; l < : l i c ~ rN
I:c:c:tsived hy (N:~rni: r t r ~ r O
l l.~iln
izar~on): - ,

I%r'c~:;~.;~r~
I C::~t~lc;/ k;\:e:i~t I!: Stnti?: I l ) : . ~ ~ u / ' l . i n ~: irt ~ b r n i t l c c l : ( 1.Jr-
as vcrlul
CICI~II~~I~*CI

PbMA Form 90-136, NOV 04


I ACTION REQUEST FORM O W No. 1660-0047

. Requesting
W h o is Assbhnca? (Completed by Rcqucstorj
I ~ T ~-.- ~ I c : s ~ I
NI~IIIC/T~~<:/SIJII.:: .
,.
,
,'
. , -

4 % t-1
1-3

\5 * -.
I r:rnpor:\ly S 1 h n n ej Pns J!:

Rt:rluc:;tu~ <">cy.n~~ij.i.~..lric~tr: L*:-~r~:ait:


A
-
11. Requested Assistance (Completed by Requestor)
~ ~ ~ 3 ~ 111'of'
i 1\9:1iolartcc
pli~ Kccluc-.;lcd:
~~All.ifltr~~l

c)
r-**oL;\ag ~ O A . ~ A ~ , ~ , Q ~ - TA~ ~\ S
~ ,G. Y
J ~j + C r h T T G ~

111. Sourcing the Rqquest - ~cbicw/~oordination


(Operntioes Section Only)
LX ovsR ~ Why: J{C T-:C I3um~aholjc. iJ ~tar~n.mtwtr(
I I I , ~II(GIW
I I,,? Cl (IIIIW (c,xpt~ic~) W inrc?ragw\c).Aq#L'enlnll
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,
COOICIII~~I.IC~I
I*:
.- nR~quiiilims 1
3 ....
MI.+..m r ~A ~ X J J ~ / I ~ ? I I ~

1-1 IVIICI. ihorditrittic~t~


{I.,:
t
l wtcr CwrdirtaUwr ~?y:

Itrrtnt:dir?lr Action l Z r q ~ c i r ~ . r l : U Y(": 1 1 rln A c t i o ~ ll-eqtci:::r 1.7 csr H :


rl:$\c/'\'ilnc A.';:;icnr-I\: 1 a:;aii:llcci lo:
.-
I I cSt11cr:

IV: Statcm.ent of Work (Operations Section O d y )


Ub'A Aulir.rr I r:tflir:cz.:
-- !!:I.h o u r I.'hanc: I'A Xit

FEMA C'l.oj<j~~'l LlClic~..~,: .2.'l 1~01.1rI'IIOIIP: I'CAX 11 --


~ l \ ~ ~ ; l i f i ~ ! i , i/l . :~I.LIL~!IIICILL
io~~ c11.14'1~1It:
1
cS? LI.I.1L,,6J4 FATI& gF,ljCs-)L*.iC,,jq
4 _-(_

[ & : c G c ~ ( ( L ~ ~ ~ \ L > fiy:>>idT


\
7-ntT \~
.-
c-0 \> x37-j i l c - 657 R PI i,\ 5 \-\ +iG i.1 ""T c;. 6 < ~
5 \\ >2 ~)<;&) t >~~ C ' k $ \ ~ .--- o
.T*G cc~.i:J- i ..I, 73" -' a - , i ( 5 . . 4 s 5 5 .I ' I 1 ' Lj

i JC. cd.3; c LL.' i2 L C.i;i=.4ALh~ c.A7. , 1. L ,A c.. ~,.-:a


- m ~ c mA-5A~L-TE11
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~ ~ ; s l i t ~,.(I
t ~ ~i tI t r t t ~ i \ ~ ~ .l');~lf::
iic~!~~ (.;[.I:~I L:li11.10
1.c:
V. Action Taken (Operations Scction Only/
(flLts-L
I ACTION REQUEST
- FORM OMS NO. l~(io-001)7
E.xprins Nvonrnhcr 30. 3007
I
I. W h o is Rcquestitq Assistance? (Completed by Requestor) -. .) .'. ..(
, -",
. . (. <*. . '. 7 ?.7--.
,-
:. .".
.-<..",-.>

C, $ 4u
.L{A-L,
I(crlttcarr,r O ~ . ~ ; ~ n i z : . r t i < . ~ t ~ :~(CL- E III~I~~:
11. Requ'stod ~ ~ ~ i s t d n c o y & o r n ~ lby
c t cRequestor)
d L-I I;,.,.Al(arla:d .
- .
bc:ci:t ipt.iot'l u1A:;:ii:;Caucc Rrquc-slcfl:

~ I I Sourcing
. thc Request - ~c;icw/~oardinntion(Operations Section Only) ' f

L):JL~/'~~IcII.
A:s:~I~II,~~~: I >c:<:+~g,~ctl
111: [A ~sh.~.

1V: Statement of Work (Operations Section Only)


Oi'A A<:lirln OJli~;c:r,: 24 hour Ish(~n(:: FAX 11 .-.-

-- (~l'lit:~~:
I~'li:MAI'!~~!~I.:I::I
I ?'I
:.? I I I I ~i:'Ilor~t!: F'AXli

..
--
E!;~.inl:~lircl(:.ornplc.ric~r\ 1'1:-$1,:: t , : o ~f.:+:Cin~:\k.c:
t -
V. Action Taken (Operations Saction Only)
I--\A C C . ~ J ~ I V < I [...A t<t.it..<-1vtl
I II::~IIS~I.I~~I: i ' r ~ ~ ~ ~ , i\.illl
l t ~ tRl'i!
~~i.~~l
--.----

FEMA Form 90-130,NUV 0 4


SEP. 8. 2005 6:31PM 662-L NO. 015 P. 3
t
;. - . -
.
Is
I
ACTION REQUEST FORM

0th cOordlMd00
Other f3mfdiMMn

~wAcSJ& Xed -tic& tpteprb;l


d)pW*Tt~d~% ~AC;(I%

TRACKING WORMATION (FEMA USE O


m W
Action Request # l~ecdvedby (Name and O r ~ t i o n ) :
R ~ g r a mCode/Evmt #: 19tate: I~atejfimeSubmitted: 1 0 OrlgiMted ari rerbd
-
8

'

i
I.

-A

Requestor 0 r g a n l z a l l o n : L &pf
11. Requested Assistance' (CompIeted by Requestor)
,
ACTION REQUEST FORM
W h o is Requesting Assistance? (Completed by Requestor)
Reqncstol- N a m e / T i t l e /

Permanent Phone.
Statc

T&<za; L7
FAX #.

E-mail.
- 4
OMB No. 1660-0047
Expries November 30,2007

C]
,

See Attached

Other Coordinat 0Mission Assignment


Other Cmdinatlon by:

Est~matedCompletion Date: 1 Cost Estimate:


V. Action Taken (OperationsSection Only)
lo
-e

Accepted Rejected Accwntable Property

Coordinated with APO


I
eCAPS/ N E M I S Task ID:
Action Request # Received by (Name and Organization):
Program Code/ Event #: State: I ~ a t e j ~ i mSubmitted:
e ( Originated as verbal

FEMA Form 90-136,


NOV 04 t
-! h
I.

-
Permanent Phone:

Requestor Organization: <',


ACTION REQUEST FORM
Who is R e q u e s t i n g Assistance? (Completed by Requestor)

11. R e q u e s t e d A s s i s t a n c e (Completed by Requestor)


Description of Assistance Requested:
Temporary Phone/ F i

FAX #I
-
E-mail:
-
-
om NO. 1660-004 7
Expries November 30,2007

- a 7
-
8
-
I

0
I

See Attached ' -'

'7C-;c;
L-. (arc> F=,r g-e(&-
I

Quantity: Priority: 0 I ~ifcsaving


200
-.. .-
- 3 High a 4 ~ediurn 5 Normal
Y
,

aInteragency Agreement
Mission Assignment

FEMA Form 90-136,NOV 04


JFO-Jf?
,*
ACTION REQUEST
- FORM OMB NO. 1660-0047
Expries November 30,2007
I. W h o is Requestinp: Assistance? (Completed by Requestor)

Requestor Organization: , j E-mail:

J
11. Requested Assistance (dornpleted by Requestor) 0 See Attached

Description of Assistance Requested:


I.
~ 7 c ~ ,-,k ; 5 ~ - .\'k
\

Quantity:
z4.20
Delivery Site Loca-
- --
-4-
,

,Q c

i030
h'p ,
6

.o.
- e.., ,
Priority: 0 1 Lifesaving
0 3 High
5 p 1 ..r3s ,
OTGfe swtatning
0 4 ~id~urn 0 5 Normal

D. J. ~ . ~ , + ~ - t i ? ~ / t
I

-- - - - - -
S ~ t ePOC: A a 24 Hour Phone: -- FAX#
State Approving Official signature: Date: 27& & le
111. Sourcing the Request - Review/Coordination (OperationsSection Only)
0 OPS Revlew by: 0onatlons Procurement
I

0 Log Rev~ewby: a Other (explam) 0InteragencyAgreement


Other Cmrd~natlonby: a Req~UltmS a Mlss~on&\gnrnent
0 Other Coordlnatlon by:

0 Other Coordlnauon by:

Immediate Action Required: U Yes No ' Action request (3 €SF #:

Date/Time Assigned: assigned to: 0 OUler:


I

IV: Statement of Work (OperationsSection Only)


OFA Action Officer: 24 hour Phone: FAX#

Estimated Completion Date: Cost Estimate:


V. Action Taken (Operations Section Only)
a lo
F

0Accepted Rejected Accountable Property


Disposition:
,
I
-
ACTION REOUEST FORM OMB NO. 1660-0047
Exories November 30. 2007
I. Who is Requesting Assistance? (Completed by Requestor) 8.dd o.@?-ut~/
R e c ~ u e s t ~Nnrne/Title/St;~~e:
i~- 9 1 n C . ~ N Temporary Phonc/Fax #:

Permanent Phone: FAX #. + .

Recluest or 01gan~zatlon E-mail.


11. Requested Assistance (Completed by Requestor) see Attached

Descrlpt~onof Ass~stanceRequested. l i b \D~OW % c [ I . ~ *Os& d:kr ti,:


J
u c m 13 it i n ~ c 4 S\\<f>c5 Cc (-) *

QLI~II~~IL\ PI lur lty 0 1 Lifesaving 2 Life sustaincng

d,00 ns 3 High o 4 Medtum s Normal


D I Sc ~ a
--. -~
.-
t~
333 ~ ~ z - OC,ic Lln
~r 1L,Cq
~ 7 0 q3
A

h r \ c ~ w- ;
~ t t POC:
e &J
State Approv~ngOfficial s~gnature:
\
& ic h % , ~ ~
24 HOUT

- Review/Coordination (Operations Section Only)


Phone: I
-

Date. d/&v6
/

111. Sourcing the Request /


0Donatlons Procurement

[11 cog Review by: CjOther (explain) a Interagency Agreement


0 Other Coordination by: Requisitions Mission Assignment

Other Coordination by:


Other Coordination by:

immediate Action Required: U Ye5 No Action request ESF #:


DateITime Assigned: assigned to: Other:

N:Statement of Work (Operations Section Only)


OFA Action Officer: 24 hour Phone: FAX#
FEMA Project Officer: 24 hour Phone: FAX#
/ Statement of Work:
Just~ficat~on

Estlmated Completion Date: . - .-. -- -_-k _ _Cast.Es~unatc --- --- - - - .- - .. - -. - -


V. Action Taken (Operations Section Only)
Accepted 0Rejected 111g
Accountable Property
Disposition: Coordinated with APO

l~eceivedby (Name and Organization):


Program Code/ Event #: I~tate: I~atej~im Submitted:
e

FEMA Form 90-136.NOV 04


"---i
'1
ACTION REQUEST FORM OJKBNO. 1660-0047
Expries November 30, 2007

I .
Who is Requesting Assistance? (Completed by Requestor) &-0 3%
Temporary Phot~c/Fnxil

FAX #.

Requestor Organ~zation. E-mall


11. Requested Assistance (Completed by Requestor) 2 see Attached
D e s c ~{ptlon of Ass~stanceRequested.
PLED6WUk723C

PJ101 1 t) a 1 Llfesavmg U 2 ~ l f sustalnlng


e Date/Time Needecl
03 High 4 Medurn a 5 Normal

' ~ e l i v e l yS ~ t eLocat-
--.
p&M vw
.- 5Tfihf'R
-23,7jb,9
-
V U ~ ,LP- 707s
Site POC. - 2 4 ~ o u r M e FAX#
State Approving Official signatuie. Date.

view/Coordination (Operations Section Only)


0~onat~ons 0Procurement
'
13 Log Revlea b y Ofher (explam) Interagency Agreement
Other Cwrd~nat~on
by: a Requmtions Mlswon Asslgnrnent

Other Coordlnatrcm by:


Other Caordlnatcon by:
-- . -- - --
UYe_S k t l o n request- -B=-%F
. -.-
I r n n p h k Action Respired. _ No - - b
: - -

Date/Ttrne Assigned: assigned to. 0 Other:


IV: Statement o f Work (Operations Section Only)
OFA Action Officer: A 2 4 hour Phone: FAX#
FEMA Project Officer 0 24 hour Phone. FAX#
1
Justification / s t a t e m e x o f Work

Estimated Completion Date: Cost Estimate:


V. Action Taken (Operations Section Only)
Accepted 0Rejected 0 nccountable Property
Disposition: Coordinated with APO

eCAPS/NEMIS Task ID:


Action Request # Received by (Name a n d Organization):
I
Program CodeIEvent #: State: [~ate/~im e
Submitted: /I;&& I Originated as verbal

FEMA Form 90-136,NOV 04


ACTION REQUEST FORM OMB NO. 1 660-004 7
Expries h'ouember 30. 2007
I. Who is Requesting Assistance? (Completed by Requestor) ZOC, /x-q"y,@
Requestor Namc/T~rk/Statr %T b h ( & c > ?beUq &sP,T4L Temporary Phone/Fax #

Permanent Phone - P FAX #

Requestor Organwanon: 57 CL( U


Q h r i ~ , ~ ~.)?,in, E-mall:

r
11. Requested Assistance (Completed by Requestor) 0 See Attached
--

-
- - -

Description of Assstance Requested:


fi Kq4e- &--
,LE> G 5 KLc

Quantity Pnority 0 I i.,fesavmg 02 bfe sustatn~ng Date/Tlme Needed:


\t3.0-
-- - -4
LI] 3 tiqh 0 4 Med~urn 05 ~mal
i
Del~verySlte ~ o c a t z :54. C u & u S Tm% f i ~ s ~ \ ~ ~
la 5-1 3-, E.~\AwLQ~-~-. -
--
~AUNJ~L--,LA TuoS-)_ -
Site POC: FAX #

State Approving Official signature: Date:


r
(111.- Sourcing
- -
the Request -seview/~oordination
(OperationsSection Only)
/ 0 oonations 0 procwement
0 OF5 Revlew by:

0 Log Revlew by: Other (explain) 0 InteragencyAgreement


0 Other Cocrdmation by: 0 UequWtlons C] w o n ~nlgnment
0 Other Coordination by:
Other toadtnation by:

Immediate Action Required: U yes 0 No Action request 0 ESF X:


Date/Time Assigned: assigned to: 0 Other.

IW Statement of Work {OperationsSection Only)


OFA Action Officer: 24 hour Phone: FAX#
FEMA Project Officer: 24 hour Phone: FAX#
Justification / Statement of Work:

Estimated Completion Date: I Cost Estimate:


V. Action Taken IO~erationsSection Onlvl
Accountable Prom

CAPS/NEMIS Task ID:


ACTION REQUEST FORM o m NO. 1660-0047
Expries November 30, 2007
I. Who is Requesting Assistance? (Completed by Requestor) FBC 0 ' - 0 8 $
Requestor Narne/Title/ State: E.zc&sop3 0s
I
\ Temporary PhonelFau #:

Permanent phi FAX #:

- ~ ~f l o ~
Requestor ~ r ~ a n i z a t i o n E ~ C & Y\ 6,-to E-mail:
11. Requested Assistance (Completedgy Requestor) C] see Attached
Description of Assistance Requested: OX E P 4 T ri\M h7 $ u p
Cerd-* hl -4s

Quantity Prlorlty. a 1 bfesavtng 0 2 i ~ f susta~n~ng


e Date/T~rneNeeded:
~ C G C S ( ~-$2 a 3 High 4 Med~um 0 5 Normal
Dellvery Site L c t o a 00 fl ou a &\ , . ,

Site POC: 24 Hour Phone: - FAX#


- - --

State Approving Official signature: Date:

111. Sourcing the ~ ~ ~ u e s t ~ e v i e w / ~ o o r d i n(Operations


ation Section Only)

a Log Review by: 0 Other (explain) 0 InteragencyAgreement


a Other Coordination by: 0 Requtsitlons Mlsslm Assignment
0 Other Coordlnatlon by:
Other Coordination by:

Immediate Action Required: L!Yes No


Date/Time Assigned: I assigned to: Oh-:

N: Statement of Work (Operations Section Only)


OFA Action Officer: 24 hour Phone: FAX#
FEMA Proiect Officer: 24 hour Phone: FAXt
- -- - - - --

Justificabon / Statement of Work:

Estimated Completion Date: I Cost Estimate:


V. Action Taken (OperationsSection Only)
0Accepted 0Rejected Accountable Property
Disposition: Coordinated with APO

eCAPS/NEMIS Task ID:


Action Request # Received by (Name and Organization):
Program Code/Event #: State: I~ate/~im
~ue bmitted:~/fy//h ~ 9 ~ 1as verbal
~nginated

FEMA Form 90-136,NOV 04


ACTION REQUEST FORM om NO. 1660-0047
-pries November 30.2007
I. W h o is Requesting Assistance? (Completed by Requestor) 5 2 D~z-pi'7- - - --
9 1
Temporary Phone/Fax #:

FAX #:

-
Requestor Organization: E-ma11
11. Requested Assistance (Completed by Requestor) 5ee Attached

Description of Assistance Requested: :


?an7Wi..c &,u,er

Quantlty 02 Life 5uRammg DateJTirne Needed:


03 High 4 Medtum
L

-
-
- - -
S ~ t ePOC: 24 Hgur Phone FAX #

State Approving Official signature: Date:


r
/Coordination (OperationsSection Only)
0 mnatlons flprocurement
0Other (explain) 0 interagency Agreement
0 Other Coordination by: Requbttbns Asslgnrnent
~isskx~
0

I
Other Cwrdinatlm by:
0 Other CoordinaUon by:

Immediate Action Required: U yes No Action request 0 €SF +:


Date/Time Assigned: I assigned to: 0 Other:

IW Statement of Work (Operations Section Only)


OFA Action Officer: 24 hour Phone: FAX#
FEMA Project Officer: 24 hour Phone: FAX#
Justification / Statement of Work:

.V. Action Taken (Operations Section Only)


Estimated Completion Date: Cost Estimate:

0Accepted Rejected a Accountable Praperty


Disposit~on: Cwrdinated w,th APO

$.wc~G$N~o&?UA'$~ON. ( F E~ ~ $ E o , . ~ , , $ ,. .: ,. : . . .-. ,
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..2--"$+~

eCAPSINEMlS Task rn.

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Program Code/Event #:
tL
State: I ~ a t e / ~ ~~ubmitted:&$&~~
me
z I V
1a
f l ? ~ ~ong~natedas verbal
F E U Form 90-136, NOV 04
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I pU ll ll
l

ACTION REQUEST FORM o m NO. 1660-0047


Expries November 30, 2007
I. W h o is Requesting Assistance? (Completedby Requestor) ' S6C ~k-0BbP)
IRcquestor Narne/T~tle/Stn~c sq.Tammfin E0c Temporary Phone/ Fax #.

Permanent Phone: . - - - - I
FAX #:

Requestor Organization: SA .TA


,. ,. c\ ,,
f@ (1- E-mail:
11. Requested Assistance ( ~ o m ~ l e t hbydRequestor) • see ~ t t a c h ~

Description of Ass~stanceRequested.
See c~-tCoo,cLe d .

a
Quant~ty.
10 --
-

-
Prlorlt~:
03H@
1 ~ifesav~ng 02 Ltfe susfatnlng
0 4 Medurn 5 Normal 1 DateJT~meNeeded:
5(13d) 23U7

Site POC: - A+ 24 H_ou; ~hony"' -FAX #

State Approving Official signature: Date:

111. Sourcing t h e e q u e s t -#vigw/~oordination (OperationsSection Only)


0 mnatlons a Procurement

El ~ m e (explain)
r 0InteragencyAgreement
Other Coordination by: a Requisitions 0Misslon Assignment
0 Other Coordination by:
Other toordrnation by:
a -
Immediate Action Required: Yes No Action request 0 €SF X :
Date/Time Assigned: I assigned to: a ~ ~ e r :

N: Statement of Work (OperationsSection Only)


OFA Action Officer: 24 hour Phone: FAX#
FEMA Project Officer: 24 hour Phone: FAX#
Justification / Statement of Work:

Estimated Complet~onDate: Cost Est~mate:


V. Action Taken /Operations Section Onlvl
I Accepted Rejected
--- - - - - - --. - - -- -- - - --

10 Accountable P m r t y
Disposition: Coordinated with APO

~ ~ C A P S J N E MTask
I S ID:
Action Request # Received by (Name and Organization): 1
Program Codel Event #: State: I~ate/~irn ~ubmitted#/3/.&
e 1
2.p~0originatedas verbal-
1 /

F E U Form 90-136,NOV 04 L
U.S. Department o

0 0th- Corndination by:


0 Interagency Agreement
0 Other Coordlnatron by:
0 Mission Assignment
r I

ACTION REQUEST FORM OXB No. 1660-0047


Expries November 30,2007
I. W h o is Requesting Assistance? (Completed by Requestor) ,EOc Ok?-09?
Rcquestol Narne/T~tle/Stace R Pp 8 OC 5 Temporary Phone/Fax #.

Permanent Phone. . -+.. L C


FAX #: $*?. g

-
l ~ e a u e s t o rOrganization: E-mail:
11. Requested Assistance (Completedby Requestor) see Attached
Description of Assistance Requested
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Quanclty Priority: 0 1 lifesaving 0 2 L~fesusta~nlng Date/Tlme Needed:


5 .
. a 3 High &6 Medlum 5 Normal /+~I++'
Dellvery Site Lqcg!r% 01-0k-!! c -T
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~:N'-P u.\k LA 1 136 O


site POC: 5537 hbb ,,,
/V?
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,
= -
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-

tate Approving Official signature: Date: o( Lv d I'

(OperationsSection Only)
111. Sourcing the ~e~u~st/~edew/~oordination
OPS Rw~ewby: Donations 0 Pracurement
a iog ~eview by: 0 other (exphin) lnteragew Agreement
Other Cocdnation by: Requisitt~s ~lsslonAssignment
0 Other Coordlnatrm by:
IJ OM^ Codinatrw, by:

Immediate Action Required: U Yes 0 Nc Action request 0 EY #:


DateITime Assigned:
- - -- - -. - - - -- - -
-
a s s b e d to:
-
0
-
0th:
-- - - -- - - - - --

IV: Statement of Work (Operations Section Only]


OFA Action Officer: 24 hour Phone: FAX#
FEMA Project Officer: 24 hour Phone: FAX#
Justification / Statement of Work:

Estimated Cornplet~onDate: Cost Estimate:


V. Action Taken (Operations Section Only)
I Accepted Rejected 10 Accountable

'-1
Disposition: Coordinated with APO

Action Request # l~eceivedby (Name and Organization):


Program Code / Event #: Istate: l ~ a t e / ~ i r n~ubrnitted:~/3//&'
e r/w 10 originated verbal
1 t f

FEMA Form 90-136;NOV 04


ACTION m u-E S T FORM OMB NO. 1660-0047

-
Exprles N o u e m k r 34 2007
I. Who is Requesting Assistance? (Completed by Requestor) M-/dd
Requestor Namc/Title/State Tern- Phone/Fax #.

Permanent Phone:
1

Requestor Organization: A 5L Ch :Q A E-mail:


11. Requested Assistance (Completed by Requestor) 0 see~ttached
Descripuon of Assistance Requested.
6e*tccw.f0,-
60 k W , 3pLw)lboY

Quantity: Priority: 0 i ~fesauog 0 2 ~ l t sustalnmg


e DateJTime Needed
/ 0 3 Htgh &4 Medlum 0 s~cmtal 3 4 0s
Delivery Site hcatig<
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State Approving Oacial signatur Date:

viewgoordination (OperationsSection Only)


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0 other ( q u n ) 0~ e r a ~ e n c v
amu- u~lssion~rslp~le"t
OthaCoardlMtlonby:
0 .yb-
lmmediite Action Required U Yes 0 HO Action request 13 ESI:
I~ate/TirneAssigned: I easimed to: omec

N:Statement of Work (Operations Section Only)


OFA Action Officer: 24 hour Phone: FAX#
FEMA Project Officer: - - ----
24 hour Phone:
- - -
FAX#
-
1 ~ u s ~ c a t i o/ nStatement of Work:

Estimated Completion Date: 1 Cost Estimate:


V. Action Taken (Operations Section Only]
accepted ~eJected lo humntaMe Property

I I
Disposition: Cmrdinated w i t h AW

TrUcWQ W R Q ~ T ~ :(O
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eCAPS/NEMIS Task ID:


Action Request # Received by (Name and Organization):
Program Code/ Event # : State: ]~ate/TimeSubmitted: ( 0 Orlplnated as wba!
J
FEMA Form 94136, lOOV 04
. I SFNT mfi/vr
r @--I 1
L
i
ACTION REQUEST FORlM OMB NO. 1660.0047
E x p r i e s N o v e m b e r 30, 2007

.-I. Who is Requesting Assistance? (Completed by Requestor] sac Q/I-/dl

Requestor Organlzatlon sw 5-mall:


11. Requested Assistance (Completed by Requestor) 0 See ~ t t a c h c
- -- -
l ~ e s c r i ~ t ~ofoAssistance
n Requested: h.( a,e a c- 5 , , , ,+

Quanllty a-
Del~verySite LO*: pIw
Prlor~ty

;
2;
T n o
~r
1 L~fesavlng
3 H~gh
;#-6
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0 2 ~ l f esusta~n~ng
4 Medlum a 5 Normal
Da te/Tlme Jeeded
8/31 / O S
/
--. --
-
-
d

~ l t POC:
e Thck LCf A - 8 24 Ho>r Phone. - - L .-nil #
State Approving Official signature: Date:

111. Sourcing the Request - nation (Operations Section Only)


0 OPS Rwlew by: Pmcurement

0 Log Revlewby: 0 Other (explain) a tnterapency Agreement


0 Other Coordlnatlon by: 0 RequlslaonS (3 Hlsdon Assignment
0

l
Othwcmrdinat(on by:
C) Other Coordination by:

Immediate Action Required: U Yes No Action request €SF 8:


DateITirne Assigned: 1 assigned to: ohr
N: Statement of Work (Operations Section Only)
OFA Action Officer: A 24 hour Phone: FAX#
FEMA Project Officer: C A j l J 24 hour Phone: FAX#
Justification / Statement of Work: I

Estimated Completion Date: I Cost Estimate:


V. Action Taken (Operations Section Only)
0Accepted 0 ReJected 0 Accountable ~roperty
Disposition: Coordinated with APO

F E U Form 90- 136, NOV 04


I
i
7-> Q M
ACTION REQUEST FORM /<so g/r//oc,
L~

- OMB No. 16600047


Expries Noucmber 30, 2007
I. Who is Requesting Assistance? (Completed by Requestor) &d &/03
Requestor Name/T!tle/ State h,'
c 4 ,L / PCX.I c y I
Ternporgy Phone/Fax #.

-- -- b FAX #%
~ e q u e s t o Organization:
r fl ,'p-& o /lj S - f s f e &., ,J [ :f-y E-mail:
XI. Requested Assistance (Completed by Requestor)
Descrtptlon of Assistance Requested: 2 300 K d , 3 fkar& 4 if0 d o 1 -f :r -7o/&
d(cr/s J ~ c

Quantity: Priority. 0 I hfesavlng 2 ~ d sustahng


e Date/T~meNeeded:
a--
. 2 b~ ~ ~ 13 3 ~ ~ g h 4 Medium 0 5 Normal
Delivery Site ~ o c a t i p a ; fl ,c L a 11 5 St& e kt.: V C / flty
-
--
-- -
&

- %':-. e+ 5~ , f J , " c e CCP


~4I/ t I

~ , h , d e ~ kI fa. -

site POC M:c(\A E ( Poo/cq


- -
State Approving Offic~alsignature: Date:

f coordination (Operations Section Only]


111. Sourcing the ~ e ~ u e s t f i v i e w
0 OPS Revfew by: 0 oona~ons p~ocurement
0 Lag Rwlew by: 0 (=&in) n,lnteragency Agreement
~ t t r e~
r o o r d ~ n aby:
m 0 rmmmn.s ~isslon~ s s i g ~ l e m
a ~ m eComilnatlon
r by:
g OtherCoonlh7amby:

Immediate Action Required: U yes No Action request 0 €SF#:


I ~ a t e l ~ i rA
n es s i ~ e d : I assinned to: Other:

N: Statement of Work (Operations Section Only)


OFA Action Officer: 24 hour Phone: FAX#
FEMA Project Officer: ( d - ' r24 hour Phone: FAXIt
Justification / Statement of Work:

Estimated Completion Date: Cost Estimate:


V. Action Taken (Operations Section Only) -.a

Accepted Rejected AccountaMe Property


Disposition: Coordinated wth APO

Actton Request # T~eceivedby (Name and Organization):


Program Code/Event #: I~tate: I ~ a t e j ~ i mSubmitted:
e ? (0
Or(gi~tedas~d
1
".
F E U Form 90-136,NOV 04
7.(@ r/l M C / > / / O / moo
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ACTION REOUEST FORM - l 16600047
a i ~ NO.
E x p r l o N o u e m k r 30,9007
: Who is Requesting Assistance? (Completedby Requestor) God l?A 4 /
&

Requestor Narne/Title/State C or /cl 7-dv< Temp- PhoneJFax #:

permanent Phone: - - .-. - C - - . b


Requestor Organization: T d - n q
Pa E-mail:
11. Requested Assistance (Completed by Requestor) 0 Seemed
Description of Aqsistance Requested:
6 c f i ~ ~ + r- 500 0 kL4 *a

Quanuty: Priong: 0 1 UesAng w ~ d sustaining


e Date/Time Needed:
2 a 3 nigh C] 4 uedlurn 05~ m d 05
3/4uc,

Site POC: L o r fa T a cwqe 24 Hour Phoy


-
State Approving Official signature: - Date:

111. Sourcing the Re oordination (OperationsSection Only)


0 0 ~ s ~ ~ 0- 0 pmurement
LW ~evicwby: othtr (exphln) 0 lmrix~encl~ g m m e n t
0 OthaCoadlnstfan~: 0- ~~kskm~sslpnmcnt
0 -by:
OtherCoordl~tiarby:

Immediate Action Required: U yes C] No Action request 0 ESF I


:
Date/Time Assigned: assigned to: 0 Oms:
F
N:Statement of Work (OperationsSection Only)

FEMA Project Officer: (/3/\ 24 hour Phone:


Justification / Statement of work:-

Estimated Comple~onDate: Cost Estimate.


V. Action Taken (OperationsSection Only)
O~rcepted o~c
ejdeb 0 Actatntable Propem
Disposition: Coord~natedwth AW

Action Request # Received by (Nameand Organization):


Program Code/ Event I: State:
>

e
-

I ~ a t e / ~ i mSubmitted: )a orlg~natcdaswrbh)

FEMA Form 90-136, Nov 04


ACTION REQUEST FORM OXB NO. 1660-0047
Expries November 30,1007
I.
C
Who is Requesting Assistance? (Completed by Requestor) , f 302~
~ md
iRequestor Nnrne/T~tlc,State: ~ F RO
C d42r.j 61: V. 7" Temporary Phone/ Fax #:

Requestor Organization: 4;Y &h E-mail: -


11. Requested Assistance (~'mpleted by Requestor) a seertt~hed
Description of Assistance ~ e q u e s t e d wcx% & - 40603d:
/ Tb , n

Quant1ty.a -@ Prioriw: a 1 ~esav~ncj Cl 2 Ltfe xlaatnlng Date/T~meNeeded:


W& b n k i ~ a 3Wh 0 4 Medium C] 5 Normal 8j31 1-130
Del~verySite G C frer\ck'&j/ 1-em e 9.t. - d b qhll t

166tS LA- t l d 4 Ib
- -

F~.*C~ s&~-,s,LR -
-
Site POC: &I/& 24 Hour p h o n e .- -FAX #

I ~ t a t e~pprovingOfticia1 signature: A/,/ & Date:


I
)
1111. Sourcing the Request :pevidw/~oor&t on (Operations Section Only)
Ooonatrons 0 Procuremant
U Log Rwew by: A 0 Other ( w i n ) flInteragency Agreement
0 Other tocrdlmtlon by: 0 ReqUlsltiMs DHlsslon mnment
Cl o t t w ~ ~ ~ n ~ :
Other C w r d l ~ W by:
l
Immediate Action Required: U yes 0 No Action request EY 1:
ate/Time Assigned: I assigned to: a - - -

SW Statement of Work (Operations (laction Only)


OFA Action Oflicer: 24 hour Phone: FAX#
C
FEMA Project Officer: 24 hour Phone: FAX#

-..- - -.___---C/

Estimated Completion Date: ) Cost Estimate:


V. Action Taken (Operations Section Only)
0 Accepted Rejected AccountabIePrapen/
Disposition: Coordinated w ~ t hAPO

- -
leCAPSlNEMtS Task ID:
Received by (Name and Organization):
State: Submitted:
i~ate/~irn e
FEMA Form 90-136, NOV 04
ACTION REQUEST FORM OMB NO. 1 660-004 7
Expries November 30, 2007
I. Who is Requesting Assistance? ICompleted by Requestor) OX - 107
Permanent Phone:

Requestor Organization: fi .+
---

6f g/9*t n L
FAX #:

E-matt:
1
11. Requested Assistance (Completed by Requestor) 0 See Attached

Description of Assistance Requested: sdd c b . J~)-4 +,DqL

Quant~ty-

De ery Site L 0 c a t i p m . ~ 71Jb ~3


oe6 ~ ~ f i -f w
~ r e 4 - c . L A - 705-3

Site. POC. 10 0
~ -

flsfi A{&&/
State Approv~ngOfficial signature-

111. Sourcing the Request - ~e*ew/@rdination


OPS Review by:

Log Revlew by:


Prlorlt~

rj6rr9
I Lifesaving
3 Htgh

@ fia*leork t =Po

~ & A a j 4 ! 4Hour Phone: -


4 Medicmi

@/qsrc/ sec3-r L ; F ~
2 L~fesustaining

(Operations Section.Only)
matlorn

Other (explain)
m

-
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5 Normal

-
=I-

0Procurement
Date/Time Needed.
i?ott(o9dl
saw-

61d4

Date.//

InteragencyAgreement
j 200
C,'C.C jTa+&-.or\

Br&c,
4k.1

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.

Other'Coordinatlonby: RequlslUons a Mission Assignment


fl Omer Coordination by:
0 Other Coordination by:
Immediate Action Required: U Yes No Action request ESF X :
Date/Time Assigned: I assigned to: a Othec

IV: Statement of Work (Operations Section Only)


OFA Action Officer: 24 hour Phone: FAX#

Estimated Completion Date: Cost Estimate:


-

V. Action Taken (Operations Section Only)


Accepted Rejected
Accountable Property
Disposition: Coordinated with APO

eCAPS/NEMIS Task ID:


Action Request # Received by (Name and Organization):
Program Code/Event #: State: I ~ a t e / ~ i mS~ebmitted:@:V3~ @$$d~mas originated v&al
1 r -
FEMA Form 90-136,
NOV 04
QhtE JVO. 1660-0047
I ACTIOW REQUEST FORM Expries Nowmber 30,2007
I. Who is Requesting Assistance? lcompleted by Requestor) ~ 6 I L04 -/m

Requestor Organization: e- 6 - - 0 E-mail:


11. Requested Assistance (Completed by Requestor) a SeeMtact~ed
Description of Assistance Requested: e l) 0-4
p f i b ~ . \ b h f~u ~ D P : V ~ G - - ~

S're &va&-ed

-Quant~ty Priority. bfmvlW Qz


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bfe sustaming DatefTime Needed:
5 - - 04 Medlurn 0 SN-a)
Delivery S ~ t e t

-
Site POC: 24 Hour Phone: - FAX#

State Approving Official signature: Date:


J
111. Sourcing the Request - R,&ewj~oordinatioa (Operations Section Only)
&.&:yb
OPS ~edw ) &J (&@ ~a~ L a 0 hxurernent
-
,-r n -
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I 0
0
Log Reviewby: '
-
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a Mlsslw, A s s l g m

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Other ~oad~nauon

Immediate Action Required: U a No \Action request 0 ESF*:


Date/Time Assigned: I assigned to: a Otha:

IV: Statement of Work (Operations Section Only)


OFA Action OfIiccr: 24 hour Phone: FAX#
FEMA Proiect Officer: 24 hour Phone: FAX#
- -

I
~istificatlon/ Statement of Work:

Estimated Completion Date: 1 Cost Estimate:


V. Action Taken (Operations Section Only)
Accepted a Rejected 0 Accoun(able mpetty
Disposition: Coordinated with APO

eCAPS/ NEMIS Task ID:


Action Request # l~eceivedby (Name and Organization): , .

:
Program Code/Event #; lstate: submitted:
I~ate/~irne 9//p9 $/@
;
I
A a Originatedas verbsl -
FEMA PO= 90-136, NOV 04
I.

Requestor Nairne/T~tle/State

Permanent Phone:

Requestor Organrzabon:
-
?US C-
11. Requested Assistance (Completed by Requestor)
ACTION REQUEST FORM
W h o is Requesting Assistance? (Completedby Requestor/
-'c f&S

G. c6
fk g- -nv y-
fl&
Temporary PhonejFax #.

FAX #:

E-mail:
o m NO. 1660-0047
Expries November 30.2007
x--/%/

0 see Attached

Quant~ty: -
. - -- - Pnorlty: &; ~~fesamg
0 4 Medium
C] 2 t f e sustalnmg
05 ~ o n a l
DatejT~meNeeded:
< scp
I
Dellvery Site ~ o c a s z . I
& % - X c ; p ~ ' ~ k t - d C 1 3 0 0 c B - h ~F f~, -
-
f@tJ *"d
r\
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Site POC: g4d
j 24_ Hour Phone: TAX #

State Approving Official signature: Date:

111. Sourcing the Re ination (Operations Section Only)


'OPS Review by: 0 Donatiom 0 ~nxurernent
0 .Log Review by: --
a other (explain) Interagency Agreement

I
10 Othercomuna~mby: 0 Requisitions 0Mission A S S I ~ ~ ~ M ~
0 Merc~adh~ontry:
a 0therCoordln;ltlanby:

Immediate Action Required: U Yes a No Action request 0 EY #:


DateITime Assimed: assianed to: 0 Other:
W.Statement of Work (Operations Section Only)
OFA Action Officer. 24 hour Phone: FAX# -- -

FEMA Project Officer: 24 hour Phone: FAX#


Justification / Statement of Work:

Estimated Completion Date: I Cost Estimate:


e
V. Action Taken (Operations Section Only)
a~ccepted a ~efected C] AccountaMe Property
Disposition: Coordinated with APO

eCAPS/NEMIS Task ID:


Action Request # Received by (Name and Organization): I /

Program Code/Event #: State: I~ate/~im


~ ue b m i t t e d q y * fz,5&d I
otiginared as verbal

F E M A Form 90- 136. NOV 04


199
r-- . ACTION REQUEST FORM Q~MI NO. 1660-0047
Expries November 30,2007
I. Who is Requesting Assistaslce? (Completed by Request04
Requestor Name/ntle/ State Lx&xT@&,&\)&%Lg3 Temporary PhoneJFax # -

Permanent Phone. , - -- I ' 4 v FAX #.


-
-Requested Assistance (Completed by Requestor)
Requ~
11.
--
..
-- -

Quantity:
* --
Priority:
n 4 - -- -
Dat /Time Needed:

I
Delivery Slte $ g a z .
f L E75;a0
O S s~ ficb(r k z -lo
-
24 Hour Phone: FAX #
-
State Approving Official signature:

-
HI. Sourcing t@eRequest Retviewf~oordTination(OperationsSection Onlg) /

0 OPS ~eviewby: $&


u
c. u,& 0~ ~ a t l o c s
0 other (explain)
0 procurement
0 Interagency Agreement
0 Log Revlew by:
a other ~oord~natlonby: R~~~ • ~ l n l~~a i1~ n m e n t
a Other coadl~aanby:
0 otherminaaon by:
Immediate Action Required: U Yes a No Action request
1 a s s i k d to:
0 ESF #:
Other.
1I
TV: Statement of Work (Operations Section Only)
OFA Action Officer:
'

24 hour Phone: FAX#


1
FEMA Project Officer: 24 hour'Phone: FAX#
Justification / Statement of Work: .,

'Estimated Completion Date: I Cost Estimate:


-
V. Action Taken (Operations Section Only)
C) Accepted a Rejected 10 Accountable ProWrtV
Disposition:

Action Request # Received by (Name and Organization):


Program Code/ Event #:
;
State: I~ate/~im Submitted:
e 10 Orlglnated as wrbal
4
FEMA Form 90-136.AOV 04
,-- 193
ACTION REQUEST FORM O~MI
NO. 1660-0047
t 1' Expries Nowmber 30, 2007
1. W h o is Requesting Assistance? (Completed by Requestor)
Requestor NamejTltlcjState , 4, 7 4 f
0"A Temporary
5.J
PhaneJFar r 1
q
-
Permanent Phone: FAX #:
Requestor Organmuon: C 17 "4 5 A // E-mail:
11. Requested Assistance (Completed by Requestor) 0 see Attached

[ IX'
yL "C L '6

Quant~ty. Pnonty: 0 1Mesavlng C1 2 bfe sustaining DatejTime Needed:


*Afw5 Y P/ 7 ' /- / ~ L j dbfl,,., o 3 ~lgh 4 ~edium 0s N m a l
livery a t :e@%'
51,
3
d d
2
*c-n-. ,

/ 7 . i ~ / d d
1 -
~ 6 % Ci.-&/
5 , , , L n 1

-Site POC: 24 Hour Phone: FAX#

State Approvmg Official signature:

-
111. Sourcing the Request ~ e d e w l ~ o o r d i n a t i o(Operations
n
V

Section Only)
CP/OPS-R.=-dw
v b
.- Donations 0 ~mcurment
Lop Review by: - 0othw (explah) 0 InteragencyAgreement
Cl m e r cardlnatron by: 0~ e w ~ o r n 0 ~lssion~ssignment
Other COwdlMaon by:

I0 Other Coordination by:

Immediate Action Required: U yes U No Action request 0 ESF I:


r. 4
ACTION REQUEST FORM o m NO. 1660-0047
Ewpries Nowmber 30,2007
I. Who is Requesting Assistance? /Completed by Requestor) Zz
-
.,!J .-t. +D
Requestor Name/Tale/Stste. aru f ,&a41 fH."l&ekporary ~ h g c / ~ xa r
Permanent Phone. .- - I - FAX # -
Requestor Organizahoon: 0 ( l - ( h ~5 4- 5 - E-mml:
n. Requested Assistance (Completed by Requestor) 0 see Attached
Descnption of Assistance Requested:
*QI=W r-r. e7-iPqlt~4-7 carL.&-5.Qb
I/ q ~ ~ ~ J ca*fl"nfch.rclh.
P.O.(. ~ u Yi b h i ~ <H o u ; ~

0Mkslon Assignment

Cwrdmnated wtch APO

IeCAPSlNEMIS Task ID:


- .- I
Action Request # l~eceivedby (Name and Organization]:
Progiam Code/ Event #: I~tate: [~atej~irn~ubmittcd~&$
e
/ .'
S/rz3g
I
1 ~Odglnatedas verbal

FEMA Form 90-136,I O V 09


- -
ACTION REQUEST FORM o m NO. 1ti60.0047

l L ~ c l i v c ~Site
y 1.~wnb11:
--- -- --
-
<
-
/ 3co Sf&cio ~f-fk.-t ,
>
&

24 Hour Phonc: FAX rr


-

Y -
-
lUX. 8ourcing q g Request Roview/Coordinntion (0&rations Section Only)
*I - 1

Du t c / T i o Amsigncd: 1 tcsrrignod to: 0 OUIPI:


I
TV: Statement of Work (Operations section Only)
OFA Action Oficcr: 24 hour Phone: PAX#
Plr:Mn r~wjc'ciOKior; a4 ht~urPhone FAXU
/ Sulrcmunt of Work:
.l\l?c3licu~ion
perom& C o n d % $ S h a c ~+ FX4 &% Lr~ke.

C U I I I ~ ~ ~ ;DHLC:
En~ir>ru~ud ~K)II I <>XI E x ~ i r n ~ i r :

V. Action Taken (OperationsSection Ohly)


~Accep(cd RcJcxW MmunrilMa~
Disposition: cmr~lt~>n~rY( AY(I
U.BI~

Action Rcyuetst W
N
by (Name ond Orgb;?izrlivn):
1~1.ecivcd
Program C d c / E v u n ~11: Istote: - ] ~ h t t / ~ i mScU ~ I ~ I ~ L L C ~ : Ill Ongnoleas-

FEhjA Form 90-136, NOV 04


L

ACTION REQUEST FORM ~ d NO.


d 1660-0047
~
'2
~ p d a November
s 30.2007
I. Who is Requesting Assistance? ICompIeted by Requestor) GBC -
M&
Temporary Phone/Fax #:

rrnanent Phone. FAX #:


-.
Requestor Organization: wf&fllUb
,
fie&
fi

E-mail: -

11. Requested Assistance (Completed by Requestor) SeeAWed


Description of Assistance Requested:

Ipriority: !J z ~ I ~ a t e ~ ~ i Needed:
rne
Quantity,

Dellvery Site
--
-
26caui: L3A ~
I
L ('JET3
~
( ~ Q
- I bfesavtn~
3 HILO o 4 Med~vm

~ ~
f suslalnmg

~
e
n N-xi I
1-13'8b kL
% 6 4 n u s ~ ,L A --
-
Site POC: A~~~~~~ (114 4 . ~ A
4 0,,24 Hour3one: -FAX#
State Approv~ngOfficial signature: Date:
C

111. Sourcing the Request -Adew/~oordination(Operations Section Only)


0 00naaon~ 0Procuremer&
O ~ o Rev~ew
g by: 0 other (explain) 0 tnterageq 4reernent
o RequiSitlons a ~ s s k mAssbMne,,t
C3 by:
ather~wrd~nation
0 OtherCoordlMtlMlby:
lmrnedtate Action Required: U Yes a No Action request f f #:
Date/Time Assigned: assigned to: 0 Other:

N:Statemant of Work (Operations Section Only)


OFA Action Oficer: 24 hour Phone: FAX#
FEMA Project Officer: 24 hour Phone: FAX#
Justification / Statement of Work:
I

Estimated Completion Date: I Cost Estimate:


V. Action Taken (OperationsSection Only)
Accepted 0Rejected 0 Acccuntable Property
D~spos~tion: Caard~natedw ~ t APO
h

DateJTime Submitted.
FEMA Form 90-136.NOV 09
F E U Form 90-136,XOV 04
f . ACTION REQUEST FORM o m NO. 1660-0047
I Exprlcs November 30,2007
I. Who is Requesting Assistance? [Completed by Requestor]
,-n
-. 1 EOC =-Sib
Requestor Name/Tltle/State:
u r n
- iX 41E-rr-ry 6(-JrvC'/
-3 -
Permanent Phone: _ - .--- FAX#; 3s
-
- - ,
111. Reauested Assistance lCom~letedbv Reauestor) n Att~ched

I
Description of Assistance Requested:
n/14d,vc.c w&J&h& LDL~-\%&b'%l%b'b%>
J
141to-b 6 d Li /..A. ~~5& I I C ' ~ ~ ~ L >

Quantity . 02 Life sustaining da-~me Needed; $; .


- 3 Nigh a 4 Medlurn 0 SNonnal ,&-sf bb
' s,"

- mv 3chO-tLP.
Dellvery Site L&a@: . I

IW Statement of Work IOueratione 8ectio11Onlsl


OVA Action Officer: 24 hour Phone: FAX#
FEMA Project Officer: 24 hour Phone: FAX#

z$z$7n,u/dK&f 4m 4 d a -
Justifi tion / Stat ment of work:
L / ~ ~ C / G ~ Z ~ R ~ / B ~
-
1

ACTION REQUEST FORlVI OD No. 1660-0047


k p d e s November 30, 2007
I. Who is Requesting Assistance? {Completed by Requ6stor) &OC DR d,\ 'r
up14
Requestor Name/Tltle/State. -- 6~'1cc\/ -
ix JIF-~I+~ Temporary Phone/Fax #:

(Permanent Phone -, FAX #.


.
Requestor Organizahon. r 2 cr6 f i * L ~ l t =
13% 1-1 wl ht Co YH) E-mail:
11. Requested Assistance (Completed by Requestor) [71 see Attached
Descr~phonof Assistance Requested: J "
m ~ o , ~ l ~x ~ h rc w ~f i u w Lac.; Wmk-hm 1 ~$TIC,CQ. 'b
LP. c5 Foltuu,s
150 -Iu ~ ~ L I - ' L ~ " Y Li -
7N
do
h M c n v c ~j 700 iv L d c LM,z~rlrL 100 in Alr c a n & ( 9- ,
4
CollcLtC
Quantity.
& ~ V V . Q ~ vb/
~ LA \ - k ~ l h . - ~

Pr~ority:
&z20C .
I ufesavmg
1 - --
0 2 Ufe sustatang
- - -
Date/Time Needed:
0 3 Hlph 4 Medw fl s ~ o r m a l &sf'
Dellvery S ~ t eL O C Z & D ~
D
LA -
I

h
N:Statement of Work (OperationsSection Only) \h
OFA Action Officer: 24 hour Phone: FAX#
FEMA Project Officer: 24 hour Phone: FAX#

!
d
Estimated Completion Date: 1 Cost Estimate:
V. Action Taken (OperationsSection Only) t

0 Accepted Rejected
Accountable Property
Disposit~on: Coordinated with APO

Won Request # l~eceivedby (Nameand Org+ization):


'rogram CodefEvent #; /state: I~ate/~b Submitted:
e

'EMA Form 90-136, NOV 04


4. &
- u 92 -2-zr
o m NO. 1660-0047
ACTION REQUEST FOFW
Expries November 30, 2007
' ' I. W h o is Requesting Assistance? (Completedby Requestor)

-
Requestor NamejT~tlefState:& ' v ~ D \ v * p&&b Temporary Phone/ Fax #

Permanent Phone: '. , - e FAX #:

&\&J~JWN
Requestor Organmtion: P a d dC E-mad:
11. Requested Assistance (Completedby Requestor) - 0 %Attached

Descnpbon of Assstance Requested:

Quantity:
SQ
Dell ery Site L o g a k ~ :
k o w x a u i c e
Priority: 1 bfesavmg
0 3~igh
d4 Md,uf 2 hfe rnsta~n~q

-
C l s Normal
Date/Time Needed:

P
Oaw Cmrdlnabm by:
OtherCacwdluatla\ by:
Immediate Action Required: U Yes 0 NO Action request a ESF lr:
DatelTirne Assianed: a s s i d to: *
N:Statement of Work (OperationsSection Only)
&
OFA Action Officer: 24 hour Phone: FAX#
FEMA Project Officer: 24 hour Phone: FAX#
Justification / Statement of Work:

I
Estimated Completion Date: 1 Cost Estimate:
V. Action Taken (OperationsSection Only)
0Accepted a Rejected 0 AcuKIntaMePmperty
Disposition: wtth APO
Coord~nated

eCAPS/NEMIS Task ID:


Action Request # Received by (Name and Organization):
Program Code/ Event #: State: l~atef~im e
Submitted: 1a Orlglnated as wrbl
FEU Form 90-136,NOV 04 9&.
- . &LJc 9iZ 2-24
,
+-
, r, ACTION REQUEST FORM o m NO. 1660-0017

p.- %o is Requesting Assbtance? (Completed by Requestor)


,Requestor Name/Title/State:
0 ,.
uL&&.hi&,n
- - - I
P&,~J? Temporary Phone/ Fax #.

Permanent Phone: FAX #:

Requestor Organization: U) CL&&\'& hM t'0 C


i)(e E-mail:
-
II. Reanasted Assistance i~dmnletedby Requestor) 0 SeeNmned

a 3 High 04 Medlum 0 5Nmal


Delivery Slte Logat.vm:
wash< 3B-a OGP 1

i7 3 8 0 % i ~ & ~, fe? ~
~~qdl%L
24 Hour ~ h
Site POC:
-o --
-
n c , ~
State Appromg Official signature:

-
- -
rn
111. Sourcing Request ~ev@~/~oordination
(Operation8 Section Only)

- q--y5A
d
O~naams a procurement
LopR-by: 0 (ewphh) O rnteragenc~
[fyothercomitnatbnby: ~' v c -j z O~esu~aons 0 HW m n m e n t
0 o t h a ~ w d ~ n a t t oby:
n
ottn?r~nalbnby:
Immediate Action Required: U Yes C] NO Action request ff #:
DateITime Asaimed: aasimed to: a 0 t h ~

IV: Statement of Work (OperationsSection Only)


0FA Action Officer: 24 hour Phone: FAX#
FEMA Project Oflicer: 24 hour Phone: FAX#
Justification / Statement of Work:

Eatmated Complebon Date: I Cost Estimate:


V. Action Taken (Operations Section Only)
O*creptw~ a~ejected 0 ~ccwnta~epmperty
Disposltlon: Cmrdrnatcd w ~ t hAPO

AcUon Request # l~eceivedby (Name and Organization):

I
Program CodeJEvent #: I~tate: I ~ a t e / ~ i mSubmitted:
e I ortginated as w b a ~
1
F E U Form 90-136.NOV 04
ACTlON REQUEST FORM 0 ~ NO.
3 3660-0047
c E w p h November 30.2007
I. W h o is Requesting Assistance? {Completedby Requestor)
equrstor Name/T~tle/State: ( , eC S',AQ-)I Temporary Phone/ Fax U:

ermanent Phone: FAX #:

Requestor Organization: Ciy


& S)'.&I( E-mail:
XI. Requested Assistance (Completed by Requestor) - 0 see Attached
Descripuon of Asslstance Requested:
ZigQ cs-ts
\o\ankgts'
plllo L a 5
Quantity. Priority: a 1 wesav~ng a 2 Ltfe sustarnrng Date/Time Needed:
(DO - fl 3 Hl9h [3 4 Medium 0S N m a l Cf 1i18b-
-- -
Dellvery Site Locattm.
.-1 7 A; c pC+S
- t315 % s ~ a c l L h . I
S\'lbs\\ , I A
SitePOC: Msqor Msrr;s 24 Hex P h b : -
- FAX #
J
-
9 -.3-
c)s
State Approving Official signature:

1x1. Sourcing the Request


-
- Review/Coordination (Operations Section Only)
7
.
Date:

O A%+- om- a~racurement


C] other (expldn) C] Interagency Agreement
0 Other Cocrdlnatbn by: 0 RequisWm MnsIon Assignment
C] Other CDordlnaUon by:
C] Other Coadlnatlon by:

Immediate Action Required: U Yes a No Actlon request C] ESF t:


DateJTimeAssigned: assigned to: Other:

N:Statement of Work (Operations Section Oniy)


OFA Action Oifcer. 24 hour Phone: FAX#
FEMA Project ORicer: 24 hour Phone: FAX#
Justification 1 Statement of Work:

d fI p c r $ n r s l r C r c f-
d a ; rrd ' ,zd&,-&-= c& hk>/Kd16~ L-T.
Estimated Completion Date: I Cost Estimate:
V. Action Taken (OperationsSection Only)
a ~ccepted Rejected 10 A c c m M I e Pmp"l

I
Disposition: Coord~natedwith APO

4
'Action Request # Received by (Nameand Organization):
Program CodelEvent #: State: I ~ a t e / ~ i mSubmitted:
e I Originated as WW

FEMA Form 90-136.NOV 04


?'t e 222 2-3~2.
. b
ACTION -QUEST FORM odds NO. 1 660-0047
Expries November 30, 2007
I. Who is Requesting Assistance? (Completed by Requestor)

Requestor Narne/Title/Stafc: &*+ m j SCi('a


1
fl- . Temporary PhonejFax #:

Permanent Phone: FAX #:


Requestor Organ~zation: &/c/e&d ~ c / ~ a f l s E-mail:
11. Requested Assistance 1 (Completed by Requestor) a see Attached

Quanbty.
k/ OM
Prior1ty: 0 1 Ufesavtng
0 3 Htgh a
x2 ~ f sustaining
e
05 Normal
Date/Tirne Needed:
4 Medlwn Y/F/&J
Delivery Slte @ ~ _ a G e :

-
Site POC: 24 Hour Phone: FAX#
-
State Approving Official signature:
- Date:

Other Coord~nationby: a Minion Aalgnment

L
eCAPS /NEMIS Task ID:
..- --
4
Action Request # l~eceivedby (Name and Organmition):
I~ a t c / ~ i mSubmitted: - ., orbhated as h i '
i
Program Code/Event #:

BEHA Form 90-136. ROV 04


I~tate: e
-
t -. /=d e -a52 - 253
I ACTION REQUEST FORM OMB NO. I 660-0047
Expries November 30, 2007 A

I. W h o is Requesting Assistance? (Completedby Requestor)


Requestor Narne/T~tle/Stak C4
i &!
\1 '
k/C,i~flk\Pr~m~Temporary Phone/Fax I#.
FAX #.
Permanent Phone P

Requestor Organuaoon: Lfi (3 6m ( 4.f k&C\ E-mail:


"
-

11. Requested Assistance (Completed by Requestor) 0 see Attached


besrrlptlon of Assistance Requested: 7 toA mlis-(!@. 63 MeR . pt$!.so $
est
(Os(ao -b 1,SU - k h&~.~~
~ e c , p p + ~ ~ ~ ~ & f e e +G , Q ; F L&
~ ~OGOQ
~ - eQd,dav,
ch Mae&i
I
-Mo~day-lCl~O T U S S & ~ - - ~ O O bJd. TAD
Quanuty.
&-
%
-
-
- --
-
hority
El 3 Htgh
1 Lifesaving
4 Medurn 05 Normal
2 ~ fsustaining
0400
e
~{sLs
Dat /TI e Needed.

~eiiverySite ~ o c a t l z . De\i ~ e ftOII;U (!,Q~~U.S (@l(ho\sou Dk *50&h ~d-diu& hdd)


w e r , So a&+ le P-SO~~G\ i s deb&efrd S h e t.~ t & e & -+ ~ R f i i ~ ~ ~ ~ a. . S
Site POC: # 24 Hour Phone: FAX #
State Approving OfficiaI signature: Date:

UI. Sourcing the Request - ~e&w/~oordination (OperationsSection Only)


Ooanatlons !Jhuc~rement
0 0mer (explain) 0Interagency Agreement
0
1 k~lsltlwu; 0 Mi* Assignment

lo
Other by:
Other Cowdlnatton by:
/

Immediate Action Required: Yes No Action request 0 €SF #:


/TimeAssigned: I assigned to: 0 other: 1
N:Statement of Work (Operations Section Only)
I
OFA Action Officer:
FEMA Project Officer:
24 hour Phone:
24 hour Phone:
FAX#
1
FAX#
justification / Statement of Work:
p0,p ; he,: 0 &l~J-J~J Po\ (ce Dp$, of u';

Estimated Completion Date: I Cost Estimate:


V. Action Taken (Operations Section Only)
OAcoepted ORejected 0 Accountable Property
Disposition: Coordinated wth AW

eCAPS / NEMIS Task ID:


Action Request # l~eceivedby (Name and Organization):
!Program Code/ Event #:
r
(State: ate
/ ~ i r n eSubmitted . [ C] Originated as vertMI
FEMA Form 90- 136. NOV 04
&;)c 22 2- 5 v
ACTION REQUEST FORM o m NO. 1660-004 7
-I .- - -November 30.2007
Exuries
. Who is Requesting Assistance? (Completed by Requestor)
Requestor NarnefTitleIState:
/
~r.6
-)
'.L:? Temporary Phone/Fax #:

Permanent Phone: FAX #:

Requestor Organmuon. LA OhvM (C


rG ~b)
& ~
E-mall:
- C] See Attached
11. Requested Assistance (Completed by Requestor)
Descrlptlon of Assistance Re u e s t g :
2c L , , s ~ . & , ~ o . ~ ~ 4 L~ $ . c ~ ~ B w + (300 c e c ~ ~ &
~ d~ i;r4xtrxY9
d -
F~Y~>L
oC,5:: c : I ~ ~-3~1, ~ ~ ~ ( / ,&;/ . ~~ d a & ~ / / S $ b Of Ki - @ > 5 , 5 z & d ~ ~

f~ a
Quantity.
5 .
( SL*d>7& goca
Priority:
$dr, 7 sJ
)@I
ba>p w
uf&vlng 2 Life sustaining
$
, gz
Date/T~rneNeeded:
p
dfifi *
.

\
- 03 High 04 M&d? 0 5 NWI
3.2, LA I

-
5 s~FCA,ULIC) -
Site POC: 24 Hour Phone: - FAX#

State Approving OEcial signature:

-
111. Sourcing the Request Review/Coordination (OperationsSection Only)
-
J&- OPS Review by: 0 00natrom [IIPmc~rement
0 L~~ R d e w by: 0 0 t h (explain)
~ Interagency Agreement
Omer Cocrd~natlonby: 0 RequWtlans M~sslonAssignment
a Otter Coordination by:
Other Coordlnatton by:

Immediate Action Required: / h s ~ e s a No Action request EK iY:


Date/Time Assigned: f assigned to: 0 Other:

N:Statement of Work (Operations Section Only)


OFA Action Officer: 24 hour Phone: FAX#
FEMA Proiect Officer: 24 hour Phone: FAX#
Justification / Statement of Work:
Aas;s7- 6r.u~. PUS^*-//

Estimated Completion Date: 1 Cost Estimate:


V. Action Taken (Operations Section Only)
OAccepted ORqeQed ID AccountaWe Property

I
Coordinated with APO

FEMA Form 90-136,tiOV 04


@c bB 2 x 4
ACTION REQUEST
- FORM w NO. 1660-0047
Exprfes November 30. 2007
. Who is Requesting Assistance? (Completedby Requestor)
!Requestor Narne/TiUe/State: f(cl r/, be),,
TI
. 5 Temporary Phone/ Fax #:
t i

l~errnanentPhone: .--
FAX #:

Requestor Organization: P 19qW9h :N s fi r , 5 k E-mail:


11. Requested ~asistance)(Completed by Requestor) - O see Attached
hrcrlption of Assistance Requested: MeL: I c X P hands& -Saf i H n i q 2 ; ;fi &ud ;t

Quantity: 02 bfe wstalnlng Date/Tlme Needed:


15- Hlqh a 4 Medtum 0 5 Normal flkw
Dellvery Site L a .a t--i o ~-7 1 b 3 \fiu) k 2
- 5,.h 2
L A
-
-
- nrG;+4w4;k
(LA 70090
I

site POC: J2 C 59. fF r n 6 h - t I 24 Hour Phone:

State Approving Official signature: Date: 7-3-03


111. Sourcing the Request ~eview/~oordination -
(OperationsSection Only)
OPS Review by: Domtfom ~nwurement

Log Review by: 0 0th- (e*plaln) Interagency Agreement


0 OUlw CoaPdlnatbn by: a Requlst!m a Misslon AsQnrnent

I
~ ~ ~ o o r d ~ n aby:
tfon
0 m-natlan by:
Immediate Action Required: U Yes a No Action request a Eat:
Date/Time Assigned: ( assigned to: n Other:
N:Statement of Work (OperationsSection Only)
OFA Action Officer 24 hour Phone: FAX#
-

FEMA Project Officer: 24 hour Phone: FAX#


Justification / Statement of Work:

Estimated Completion Date: ( Cost Estimate:


V. Action Taken (OperationsSection Only)
Clmepted a~ele~ed
Disposition: Coordinated wth APO

Action Request # Received by (Name and ~r~anization):


Program CodelEvent #: State: I ~ a t e j ~ i r nSubmitted:
c 10 origl~tedas w
2

FEMA Form 90-136, NOV 04


,. 1 62c &I2 2q2
L
ACTION REQUEST FORM o m NO. 16600047
L .': Expries November 30,2007
I. W h o is Requesting Assistance? (Completed by Requestor)
Requestor Name/Tltle/State: I*-( 6, ".- 0 7 <I To./ h.OC Temporary Phone/ Fax #:
-
Permanent Phone: FAX #:

-
l ~ e s u e s t o rOmanization: E-maii.
- ...-.- .

11. Requested Assistance (Completed by Requestor) U See Attached

I
Description of Asz~stanceRequested:
21 O 5 s rdr w ~ PT~ P ' 7 L
I; FQ
hJ&xitd966
r r r , ~c /+dr
~~SL
r
9edC
kd)
J OC4

Quantiiy: Priority: a 1 bfesaving 2 bfe sustam~ng


m Date/T:me Needed:
/ z4 03 H q h 0 4 Medurn 5 Normal 6 SdP 05-
Dellvery Site LM~~TG:
-
site POC: *& g r )
10 f T;d ~ L P R 24 Hour Phone

State Approving Official signature: Date: 4 5-eFdr


XIS. Sourcing the Request - Review/ Coordination (OperationsSection Only)
0 OKRevlewby: I Donations 0Procuernent
0Interagency Agreement
0 Other Coordination by: MISSIO~ Arsignment

0 Other CoordinaUon by:


a Other Coordination by:

Immediate Action Required: U Yes No l~ctionrequest 0 E% #: I


D a t e f T i e Assigned: I assigned to: ma:
IV:Statement of Work (OperationsSection Only)
-OFA Action Officer: 24 hour Phone: FAX#
FEMA Project Officer: 24 hour Phone: FAX#
Justification / Statement ofWork:
/
Asgcrrd6Kl. / 72 f P t ? f oK&-ice
&,?C 4 . c ~ & ' a dour. ~ c ~ * ~ ~

Estimated Completion Date: I Cost Estimate:


V. Action Taken (Operations Section Only)
0 Accepted aRelated 0 Accountable Property
Disposition: Coordinated with APO

Program CodefEvent #: i~ate/~im


Submitted.
e

FEMA Form 90-136,NOV 04


P-.
2 2 2vti
ACTION REQUEST FORM ~ 1660-0047
lNO. ~ l
Expries November 30,2007
4i

I. Who is Requesting Assistance? ICompleted by Requestor)

E-mail:
-
11. Requested Assistance (Completedby Requestor) 0 See Attached
Descnption of Asststance Requested:
06.
L
Quantity. Pnonty: 1 ~fesav~ng a 2 bfe wnatn~ng DateJT~me
Needed.
(33um C] s ~ormal

-
4 Medlum

- -- - 306 E n u
Dellvery Slte Lac&m:
A ? .ax \

-
---te, 3-L -
-
site POC: $ 0- 24 Hour Phone: - FAX#
-r
State Approving Official signature:
==a
III. Sourcing t b e Request Re - \

~oor%ination
(Operations Section Only)
O P S R ~ w
by: a matlorn Procurement

0 cog~dewby: (expb~ 0 rnteqency Agreement


a other coordlnauon by: 0 Requlsltlons Crs ~lsslon~ n m e n t
a ~ C o o r d l M m by:
a other~oonl~natlon by:

Immediate Action Required: U Yes [7 No Action request Esf t :


Date/Time Assigned: assigned to: a Other.

IV: Statement of Work (Operations Section Only)


OFA Action Officer: 24 hour Phone: FAX#
1
FEMA Project Officer: 24 hour Phone: FAX#
Justification / Statement of Work:

Estimated Completion Date: I Cost Estimate:


V. Action Taken (Operations Section Only)
0 Accepted Rejected 0 AccountablePropertV
Disposition: Coordinated with APO

f
Action Request # l~eceivedby (Name and Organization):
Program Code/ Event #: \state: I ~ a t e j ~ i mSubmitted:
e 10 owinaced ar
B
FEMA Form 90-136.NOV 04
ACTION REQUEST FORM om NO. 1660-0047
Expries November 30, 2007
I. W h o is Requesting Assistance? (Completed by Requestor) EN- D R - &cf
?questor Narne/T~tle/Stnte. dRV 0 le-5 1
b ?re \Dl/&rI! t Temporary Phonc/Fax r

Permanent Phone- SO(l-2 'f 05x5 FAX #-

Requestor Organuatmn- $ ~ ( p /). ,-1 on,5


,g F:r
*$
9 ,/?A. E-mall: -
11. Requested Assistance (Completed by ~ e ~ u e s t o r l a see Altached
Descripuon of A s s ~ s t a n c eRequested.
se€ fi4tac-Xcd
Quant~ty.
a;L; prlorlt~ 8; ~esvicg
a
0 2 ~ i f sustaining
4 Med~um
e
5 Nmal
Date/T~rneNeeded:

,
-poFO
Dellvery S ~ t eL o c a u o n i
-
-
A

site POC: f l d f ~ 0f ' ~ f l w


J Cj / ~ 24 Hour Pho \ ! #

State Approving Official signature: Date:

0interapency Agreement
O MISSIWAsslgnrnent

F E U Form 90-136; N O V 04
,
I 2
. f ~ ACTION REQUEST FORM OMB NO. 1660.0047
w
Exprlcs November 30,2007

54 -
I. Who is Requesting Assistance? (Completed by Requestor) ) ~ o c - ~$72-
K
Requestor Name/T~tle/Stste: Aflfi V
I
0 6 d? Temporary PhanejFax #:

Permanent Phone: , .u4-


- 1
1
I & , * I FAX #:

Requestor Organization: ,57. T & ~ f l y. 0 E-p E-mail:


-

111. Requested Assistance (completed by Requestor) 0 See Attached

I OF-F ic e 7vra:Ie r
Description of Assistance Requested:
i W/.~L,
6a~--hwo*3. T-ikrs ~;c
b = *Ie a - + o Y t d . -i'-;le/ ,;~lb
1
7 2 3 LdLA Ci-(0 p&Ap- . 14d c .

Quantrty:
-
-
---- Priority:
a x 3 I-ligh
1 bfesaving
04 Medium
0 2 tile sunamtng
n 5 h a l
DateJTime Needed:

-
-
-
site POC: u e - 0 ~ - 1(5o
State Approving Official signature: Date:

111. Sourcing the ~e~uest/Review/~oordination


(Operations Section Only)
WSRW~W.: /$
j ,)&$& ~ 4 Cj~
~omttonr . ~mcurement

Log Review by:


-
/ other (explain) 0 Interagency Agreement
0 Other Caadinatlon by: • Requlslt10(15 Mi& Asslgnmm
a Other Coadlnatlon by:
IJ other Coadlnatbn by:

Immediate Action Required: U Yes a NO Action request ESF I:


Date /Time Assigned 1 assigned to: fl Mher.

N:Statement of Work (OperationsSection Only)


OFA Action Oficer: 24 hour Phone: FAX#
FEMA Proiect Officer: 24 hour Phone: FAX#
C
Justification / Statement of Work:

I
Estimated Completion Date:
V. Action Taken iOueration8 Section O d v l
Cost Estimate:
I
--
Coordinated with APO

0 ( 0 . .' , . , . :
- -
1
..
. . ;.
-
: r
-
:'.' - - . ,3:'. .'
: ..I J,>(
I..

eCAPS/NEMIS Task ID:


4ction Request # Received by (Name and Organization):
1
Program Code/ Event #:
- - -
State: I~ate/TimeSubmitted: 9LT < 1 ~riginatedas verbal

'EMA Form 90-136. NOV 04


Eoc m- 3 8 ,
i ACTION REQUEST
- FORM o m NO. 1660-0047
Expries November 30, 2007
I. W h o is Requesting Assistance? 1Completed by Requestor)
Requestor Narne/TlOc/Slate: S t , &r na Temporary Phone/Fax #:

Requestor Organization:
- 1 ONL FAX
E-mail:
#:

11. Requested Assistance (Completed by Requestor) a see Attached


Descr~ptionof Assistance Requested: I I I

Quantity: Priority: a 1 ufesaving 2 tlte sustatnlnp Date/Time Needed:


.Dellvery Site ~dr.a%. 60 3 W h 4 Medium 5Nmal 9-9- O S / O O O 7

ZOO W. 3.nernacd tlwy -


thalllzafte, LA --
Site POC: /,&dsy 24 Hour Phone: - FAX#
I
State Approving Official signature: Date:
/dl&-
111. Sourcing the Reques$ - &ewf ~joyrdination(OperationsSection Only)
a OPSRMnr m - y h Donations OProcurement

a Lag Revlew by:


/

4 other @whin) a cnte-q ns(eement


a Other Cowdinatlon by: RequWtions 0 Mission Asslgnrnent
Cl Other C ~ ~ ~ I M MW:
OII
Other C o c r d i n a ~onby:

Immediate Action Required: U Yes a NO Action request 0 €SF t:


Date/Time Assigned: assigned to: 0 t h ~

TV: Statement of Work (OperationsSection Only)


OFA Action Officer: 24 hour Phone: FAX#
FEMA Project Officer:
Justification / Statement of Work:
24 hour Phone: FAX#
I
J
Estimated Completion Date: Cost Estimate:
V. Action Taken (Operations Section Only)
a Accepted fl Rejected 0 Ac~~~ntabkProperD/
Disposition: Coordmsted with AW

I~CAPSINEMISTask ID:
- . .- a
Action Request # Received by (Name and Organization):
Program Code/ Event #: State: I ~ a t e / ~ i r nSubmitted:
e y/s/& (0
Orlg~natedas wrbal
3
FEMA Form 90-136.NOV 04 /t,!+KJ- -
CI

-
C
f 3 C -0P- - 336
I
f
ACTION REQUEST FORM o m NO. 1660-0047
Expries November 30,2007
I. Who is Requesting Assistance? (Completed by Requestor)
Requestor Narne/Title/State: or lea q
, s tc. p h Temporary Phol~elTax#

Permanent Phone: FAX #:

Requestor Organlzat~on: E-mail:


11. Requested Assistance (Completed by Requestor) n - 0 See Attached

-
-- -
Delivery S ~ t eLocation-C
- 4
;tyHa/1
-f3 00 P*rd;d e S*. \

/ d w n r l e a & s . LA 7 4 / 1 2 -
Site POC: She,r; Lamdlr u , ,,24
., Hour Phone: - FAX#

cl;y &
,
-
state A p p f i , b~~9tk%nc,Lr2:
I -/ A&
1111. Sourcing the Request - ~eview)~oordination
(Operations Section Only)
[TI ~ P Revfew
0
S

~ o Rwkw
g
by:

by:
I
- -
0 Donations
5 Other (explain)
0Procurement
Interagenw Agreement

Other CoordinaUon by: Requisitions 0~ k s i o n~ssignment


a Other Coordlnatlon by:
Other Coordination by:

Immediate Action Required: U Yes No Action request 0 ESF #:


I~atel~im Assimed:
e I assimed to: Ocher:

IV: Statement of Work (Operations Section Only)


OFA Action Officer: 24 hour Phone: FAX#
FEMA Project Officer: 24 hour Phone: FAX#

I
Justification / Statement of Work:

Estimated Completion Date: ( Cost Estimate:


V. Action Taken (Operations Section Only)
a Accepted 0Rejected 10 &countable Property
Disposition: I Coordinated with A W

Action Request #
Program Code/ Event #:
Received by (Name and Organization):
State: (~atef~im Submitted;
e ( 0 Originated as verbal
- Y

FEMA Form 90-136,NOV 04


-
4' gee 333
-b(;2.
ACTION FtEOUEST FORM - o m NO. 1660-0047
Expries November 30,2007
1
I. Who is Requesting Assistance? (Completed by Requestor)
Requehtor Na~~le/'Tille/State>-c rc; $ f- L#/J Temporary Phone/Fax #

Frrrnanent Phone FAX #:

Requestor Organuat~on: ,+@em,h /A Po, Eoc E-mail:


11. Requested Assistance (Completed by Requestor) - See Attached
Descliption of Assistance Requested:

f;li
C ~ ~ / F * ~ ~ : n h ,~ hA eD cL (-
A ,nl~/',~~r,,q
~ TL Lltif7

~f Lo c k 7 s .
A FGF
/f>,It7 ~ - 0 / i l ~ n ~ n p
Quant~ty- Priority: I Lifesaving 2 ~ i f sustalntng
e Date/T~meNeeded:
& / ~ ~ 4 ~ c l 0 3 Hgh 4 Medlum 5 5 Normal 9/7/03
Delivery Slte Locatlqni --
-- -gbTucr,her &r.~.rA Edc I

~
t - f & l ~Yc
u '7eo
kA-1
-
CY I 1
-
site POC: ;/>(fie $? ,&-/f 24 Hour Phone: FAX#

?
C
' Ld
State Approving Official signature:

111. Sourcing the Request


/
gi6-y
- Review/Coordination (Operations Section Only)
OPS Rev~ewby: fl&h,yw ID hnatlms 0Procurement
~ o Review
g by:
/ Other (explain) InteragencyAgreement
Other Cmrdnatlon by: Requlsltions [gMission Assignment
Othw Coordination by:
Other Coordination by:

Immediate Action Required: adcyes (r% No Action request ESF #: c-


Date/Tirne Assigned: Y / ~ / C(
I

N: Statement of Work (Operations Section Only)


OFA Action Officer: 24 hour Phone: FAX#
FEMA Project Officer: 24 hour Phone: FAX#
Justification 1 Statement of Work
-A e < { e ~f a I /;f; fw lf"mL=I~&*H<

Estimated Completion Date: 30 re f 05 Cost Estimate:


V. Action Taken (operation$ Section Only)
0Accepted baj~ e ~ e c t e d 10 Accountable Property
Disposition: Coordinated with APO

eCAPS/NEMIS T a s k ID:
Action Request # Received by (Name and Organization):
Program CodelEvent #: State: (~ate/~im .
Subm~tted:
e I0Originated as verbal
*
FEMA Form 90-136,NOV 0 4
Ea(, rJp - 554
.: ACTION REQUEST
- FORM OMB NO. 1 660-0047
Expries November 30, 2007
t
I. W h o is Requesting Assistance? (Completed by Requestor)
Rec~ueslolNa~ne/Tllle/State: ;J&--fl'c
Jf- ?'emporary PhoclejFax #:

Per~nancntPI- FAX #:

Requestor Organization: ~ / ~ ~ , PAn2


, ~ ~6 7, c.h ~ ~E-mail:
11. Requested ~ssistande(Completed by Requestor) a See Attached
Descr~ptionof Assistance Requested:
&f- 7)-a d,c5-5 +& 5kc---
(2uant1t~~ ior~ty: 0 1 Llfesavcng 2 we sustaining Date/Time Needed.
AT n/&&e&
-
Dellvery Site ~ o c a k w z z / &
- fie&,&
03 High
,-Pd*fi-,l, Eoc
4 Medurn 0 5 Normal &A73
I

7 / 63 A\/
39 ~ u kr r o c -
ikih-~aik
j u t 7 ~ 9 0 -
S ~ ~ ~ P O.ri-fj;e
C: Jj+&mqj+- - 24 Hour Phone: A FAX #
State Approv~ngOfficial s~gnature:

111. Sourcing the Request - ~&view/~k&dinat.ion


(Operations Section Only)
e O P S R ~ ~ Ity:
~W /A >i/r&
s
Donations procurement

0 Log Rev~ewby: 0other (expbln) Interagency Agreement


OMer Caord~natlonby: Requisitions Mlsslon Assignment
Other Coordination by:
Other Coordinatian by:

Immediate Actlon Required: Eyes No Action request €SF t:


Date/Tirne Assigned: cjs/7/C assigned to: Other: (k&-
I .

IV: Statement of Work (OperationsSection OnIy)


OFA Act~onOfficer: 24 hour Phone: FAX#
FEMA Project Officer: 24 hour Phone: FAX#
Justificabon / Statement of Work:
~hfit$

'Estimated Completion Date: 30 <e/rf~ I Cost Estimate:


V. Action Taken (Operationsr~ection
Only)
m~cce~ted Rejected a Accountable propetty
Disposition: Coordinated with A W

eCAPS/NEMIS Task ID:


-Act1011Request # Received by (Name and Organization):
Program Code/Event #: State: Date/Time Submitted: - 1 Originatedas verbal

FEMA Form 90-136.NOV 04


EG~.
- \ 3 g - iGT
.I ACTION REQUEST FORM OMB No. 1660-0047
Expries November 30, 2007
I. W h o is Requesting Assistance? (Completedby Requestor)

&G~'Y
/, 'I'ernpo~ary Phone/Fax #

Permanent Phone ;, FAX #.


Requestor Organization: &/?-/A Q!/ E-mail:
11. Requested ~ssistandk(Completed by Requestor) - 0 See Attached
.
I
Description of Assistance Requested.
~ c ~ d c, Xr Tf 1 0 ~ 3 l f6 r c ~/'-
m
l r X ~rlr/iu ?/e/ek
0, &fi$~y /

Quant~ty Piiolity: n 1 Ufesavrng @ 2 ~ l f esusta~nrng DatefT~rneNeeded.


a/ ne.&Gt o 3 nigh o 4 Medlum 5 Normal
AYA/"
Dellvery Slte Locat~-o~.=
-- -
sP/df~i.err)ii)e~ PuR(k ECC t

34 (t(,"* Zc 2- -
~ ~ ~ ~ 4
~ D O ~ O ? a , -
Slte POC: 3Ff-f'C I-j &dMf- 24 Hour Phone:.
-
State Approv~ngOffic~als~gnature: Date:
, 7/aJ-
111. Sourcing the Request - ~e<iew/~ooydination
(Operations Section Only)
~o~ticns 0procurement
Log Review by: 0mer (explain) 0InteragencyAgreement
Other Coordlnat~onby. • Requlsibons Mialon Asslgnrnent
Other Coordlnabon by:
0 Other Coordination by:

Immediate Action Requ~red: P6Ye5 a No Actron request EK#:7


Date/T~meAssigned: 9/7/3 9 assigned t o 0 Other:
IV: Statement of Work (Operations Section Only)
OFA Achon Officer: 24 hour Phone: FAX#
FEMA Project Officer: 24 hour Phone: FAX#
Justification / Statement of Work.
R~,&+ ZT rw(f a h s f p l ~* d
Ce , ~
kc/&,>&
l
cr , r b / ~ c e =+ /?archA
C~&A F c K / ~ ~ Erne0 .
pFoo r. ch ocfil w 0'
4 A ~ f i r c: LQ, 2 9111111)
Estimated Completion Date. 0 -30 Cost Estimate:
V. Action Taken (operation: Section Only)

1" ~ccepted
Disgoslt~on.
uefeaed A~COufltaMeproperty
Coordmated with APO

CAPS/NEMIS Task ID:


Action Request # I~eceivedby (Name and Organization):
I
Program Code/Event #: State: I~ate/~im Submitted:
e 1 Orlglnated as verbal

F E U Form 90-136,NOV 04
b
33 8
8,

w
- ACTION REQUEST FORM OMB No. 1660-0047
fkprlar November 30,2007
(I. W h o is Requesting Assistance? (Completed by Requestor) .FAC;I -04- 33 ,F
'7
( J R ~ X5~
Requestor Name/Title/State: Temporary PhonejFax #:

Permanent Phone: 225 -7 h--\ 1cf FAX #:

Requestor Organization: 0r2 E-mail:


11. Requested Assistance (Completed by Requestor) (7 see~ttached

Description of Assistance Requested:


[ O G O G ~ L w oC-- FOAIYI-CL-AUA 7 0 BE WED
I
F- U e c ~ ~ o ~bi rbzxo ~ 5 A/ 4- / u / / d f l > o -
Quant~ty'
l o o 0, c ( @ 13
Prlorlty.
3 High
I bfesavmng
a
0 2~
4 Ned~um
~ sustatn~ng
f e
C] 5 Normal
DateITirne Needed:

Dellvery Slte ~ a c a & - g z=-(IH~ Fl k~


(goo0 h
t

NE ~ T Z \ V I L

(ate , Cq
MLZAI
site POC: 2 we J E ~ E.
, 24 Hour Phone: Z z ~ X ' f 2 64- I 1% FAX #

State Approving Official signature:

111. Sourcing the Request - Re erationa Section Only)


pa:~ P RWW
S W: flh,y/w dO,- O~a~t~=ms ~roamrnent
' 4
0 Log Renew by: f l other (expln) 0 Interaaemv Agreement
~ l h e r ~ wby:~ ~ t t ~ ~ 0R ~ I W Cln~sstmA ~ Q W
0 0 t h ~ w r d t n a t i nby:
0 Other Coardinatbn by:
immediate Action Required: U Yes a No Action request f f *:
D a t e / T i e Assigned: assigned to: Other:
I

N:Statement of Work (Operations Section Only) 4

OFA Action Officer: 24 hour Phone: FAX#


FEMA Project Officer: 24 hour Phone: FAX#
Justification / Statement of Work:

,Estimated Completion Date: Cost Estimate:


I
V. Action Taktin (Operations Section Only)
m~ccepted 0 Rejected 0 Acccuntabk W r t Y
Disposition: Coordinated with APO
1 .

:CAPS/NEMIS Task ID:


Iction Request # Received by (Nameand organization):
'rogram Code/Event #: State: I~ate/~im Submitted:
e 1
0o,,gutsted as vlrbar
3
'EMA Form 90-136. ROV 04
. ,-
I

Requestor ~ a m e / ~ i t l & a t e /
Permanent Phone/Fax #.
Requestor
Organization:
State U
-c_@

EMAC
ACTION REQUEST FORM

I. Who is Requesting W i s t a n c e ? (Completed by Requestor)


lV e w o

U ROC
~ /=(% D/ e p r ~

U EST

11. What Needs t o b e Done? (Completed b y Requestor)


ERT*
~ l ~ e m ~~o r a Phone/Fax
E-mrul:

ERTIQH) 0 OR
ry

-
# -
o t h ~ 4 - K'&
U See Attached
-

bescrlption of Ass~stanceRequested: ~ p v,'dc


0 c @T cc1-7 S t FII I t- )OOO e(.~cry-
strgehb~rs :4 6 R ~ be.
t RLPL P C O V ~ L P ~ L 4 s h h a 2 ~w'tb h 3dUPCO -X-
U ? -a$ t p l s ~ b y~ l r e d6 ~ ; ) ' ~ ~

Other Cowdination

TRACKING INFORMATION (FEMA USE ONLY)


Action Request # Received by (Name and Organization):
Program Code/Event #: State: I~ate/~im Submitted:
e I Originated as verbal
I

, + '
$ .:

As of 9/7/2005
ACTION REQUEST FORM O M B N ~16600017
.
Expr(ra Nolrr-r 30,3007

r
I. W h o is Rcqucating A s s i s t ~ n c e ? (Completed by Requestor) &::.,- ?we,
Jfi

LC. mnil:
-

11. Requested Aseistnncc (Completed by Requestoal) [:I ~ e Aaachc-4


c

Ilcscrip~ia.inof Assistance Ur-c\ur.stcd: .


L c'llM.L&Jl, 0 c.:
0 c;:
--
4-. p;!:). .- (:.,i ~.:i:~,
i 44 -3. ;I*
,* .
t?:k; L.;,.!, t--::i>

fl-.
(;:it: ) i (,<.:t' ck..v.< .C.tes~ISP5 ;/- - f - j ~ ~ ? X-L* /I ,'1.y/7.,'GI.- .
I
/..':''-'"
.-
(Cuilnriry:
\ Cl (3 R-it~ril~: i it!,,~, Clj 2 !if~
rwtai~~ng Dnle/Tiune Nccdedr
-
;I!.
pjT j3 II+P~ rjj,a ~cifitcn . U s ~ormd
I&. F,
;-7
Utlivcxy :Site I~t.mz&,n:
--. -
e
[-c.phi j --. Gz7
-l'"L, L\C\V hlG. L;.
- -
\

%
,I Czi c . , C4 --
site i>t::~z: S 'r l:~e .-
.- -1L- .L_L.,ki. 24 HOWPhome: :~ > -
: fiXn
-
&fu(-@~ k..
.. -
S U t t e Appmving OfZicid xipattcre:

-
ljl. Sourcing the Request ~ e ~ ~ e w / h o t d i w t (Opcr~tiancr
ion Section Only)
p pfiz~h,,
mwewtlK .<. ,c..q uhutwn nr
m wa~l
I
'L7 twneviewyr 1
nam( l c ~ * n ) r:l buowrnuv VCC-
a ~Jlfm3 OnrdlWtlo,l tY: aW W ~ ~ aw7.hlk;skP,merit
0 wr cwinwun by:
L7 WlarcmdlMt(c**ty:
hction ~
lmmcdia~e ~ m 13 NOr a Adion mqtrcst 12 ff r:
DatclTbtre Assil(ned: ocisilg~ncdI<#: a W:
I l k Ststemeat of Work (Operations Secetion Only)
OFA Actiun Oflicer: 24 hour Pt~ur~s: FAX^
FEMA I:*c.$ecr Olrier: 24 hour Phone: FAX#
JlrstiS~:t\tion / Slntcmenr of Work:

E~timntcdConrplctir~nniatc; I Ccrtsl IEsrinlarr:


w ~ .Action Taken (Opcntions Fectioa (Dnly)
C3wtdsd 01*:lpclnr 0 LCCIW?M~ RuKvtv
Diap?titiclrl:
-
C~wnibnntdwith A N 1

) ~ a r c e i v t dhy (Nomc nmd brganirntiorlj:


1st;ntc: lbatel~imcS;lbmittetJ: 10@;awednm&'
PEWh Form 90-136. ROV M
!* C -
ACTION REQZWEST FORM I~MRNO. 1660-0047 I
Nt1i~1~tbc.r
Krr~rla~ 30, 3007
I.
I"
Who i s Requesting Asaistancc? (C2omplctcd by Ricqucstor] p, ; -, ,; ,;;; - i

K ~ : ~ , \ C I ~~~~~ ~. : lI C
~ It ~~ l l i *~
/ -~, {~A\ - Y
~ +
~ ~ l t . j&j\,- IX-III;III:
11. Requested ~sdstance'fdom~letedl
by Requestor)) - (3 !A?P hlrectwd .
t

11. Sourcing thc Request - RevicwICaordination (Operations Section Only) -' f


I

tI;c~c:/Ti~r~-.
Assi~c~t.cl: 1 lo: 1-j
:c,:si~j~n~,xl C R ~ :

1V: Statement of W o r k (Operations Scmtlon Only)


I )I;A fital.i1.wCOfir;cc.: '24 Ilonr M~otnr: PhXI;
FKMh I'rldccl C1l'I'n:t:r: 24 hour l'hon~c*: FAX#
:

--- -.
~ ~ I ~ I ~ ~I ~ II I ~~ .I I: ~~~Ir~;~t(:;
I~:I~I.~I~ 1 03.7t1. Estimutc:
V. Action Taken (Operations Section .(Only)
M C P I ) ~ nrwmF6
I-,i 11.1 Acfount~MaPryWrty
~IIS.~WI%;I it.811: (:,~~I~I~,U.II.I
CHI- r\t\a
-

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A~.lir>nRecltlc..
. . i t - # Itl2cr:eivcd I?y(N:uam.amdC.,r~~~~k:.~~ii*ct):
.-
. Pro1:ram (.:~wlr./ Evcqc g:

FCMA Form 90.136. ROV W


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. &
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nl HOIT)G~DII() r
OM0 No. 1660-OM7
~ygc,,~.y
Ffldel:~lEmurge!ncy MJnag~~iiont See l?cvcrsc lor
. . P:lpelwork O~tlclosurc. kxtnn!~Nvve~nbcr30.2007
c A
- REWEST

4. Dale and Time Nccdcnl

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r -
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r (OporaHons Suction OM^)
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6. Auiun Request €SF# Otm 7. AS...~~IWto

I . < F A Action OWiw


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4. FEMS Projecl afiir: 5.24 HW RI~=
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V. ACctlon Taken (Operattions Sact(on ~ , l y )
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khpi-ir* N u u r t n r b o ' 30. 2007

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111. Sourcing the ~ e ~ u -dReview/Coa,rdlnation


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FEMA Pvrah YO- 136. NOV t
M
I ACCTION REWEST FORM - W B Nb. 1660 0047
Fprlaa November 30. 3007
. Who is Requesting Assistance? (fcompleted by Wequestor)
"

-- ... FAX #.
' ~ c ~ r \ e s t a~rfibnimrion:
r <j . ~ G J i. ct $ (J~-).j c-cttaik , -
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11. Requested Asslstancc (Completeid by Request-) i l !h~~w~med

Rcc~uc:;ted:
Ucacriptian of Ass~star~cc

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V. Actlon Taken (Operations Section moly)

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Actinn Refluest R lmrceivcd by (Nome mrtd i~r~anirnliun):


Pnqyam Cde}Evcnl I : .WW; Submitted:
Il~dr~/'fin.le 1 mtprwod r -h.l

flgUV-90-136.1WI*OI
te]v v a l v r I
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38Ll
AkcTgon REQUEST FORM OW? Na 1660-0047.
r q d c s h u - m k r 30.3.007
Who is Requesting Assistance? (fcomplefed by.Requentor)
Y
t4r:;tut ~ung~c/.ritlc/~a.c; -';4 , c, 0 2. + G\ 0,
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FAX 4:

u e ~ Organimtmn:
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t-catail: . -
Assistance (Completed by Requestw) Ill se~tw~a

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I oraiignrvl to: U Uthm

:Statement of Work (Operations Sccctiaa Only)


24 hour Phomt: FWa
FEMA Prtjcct OKiek-. 24 hour Phontc FAXI
/ S!.;rlcm~ntor Wnrk:
.Ju:~tifi~tiocl

Dote:
Esltmorrd C~~ripIctiftn I C'WU Esrtrnatt:-
,V.Action Taken (Operations Sbctlon (Only)
7
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Pcrrrl;rncnt Flrot~c: I FAX Y:


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-11.
Rcaueu~ot-Orrrqizarin~,:
Requested Assistance (Completcrrd by Rcquestoa)
- -
E-mail,
Ll WXII~~

Oescripuon I>[ Asaistnt~ccNt-q~tccted.

COTS
l'riority: J'( l.dc-;rukq
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~311ted >pfJJ. -
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tmmcdiirk A c t h Reguwal: m Acllon twqucfit Esf C:
Ontc/Tl~mnsnigncd: u s a t ~ n e d$0: 0 0th:

IV: Statement of Work (Optcatlorn %action Onw


24 hour tbironar: FAX.
24 hour R~omrc: FAX#
I

,E~ttrbmrcd
Cotnpkti~~n
Uatc: C ~ ~.stimctte:
C
f ~ Action
. Taken (Operations Section (IDnlp)
UMC- nR.kccm
Dicpclw~r:: lirnrdrrtnlrd w r d A M

-
-
Prggrnm CnReiE~crc~
f/:
]~&t-eived by (Name hnd Organta~tiotl):
l~ltae: ] ] ~ ~ t c f r ; mSubtnbcd:
c IU
F f f M Form 96136. NOY W
PAGE 02/03

I
39/08/2865 03: 07 9408985231

ACTION QUEST F
DHS FEMA REGION S I X

O ~
~pao-c~ i o l OMB No. 1660-0057

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,I c~npot'n~y I::
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11- Requostcd Assistance (CompXetod by kequrstor) t-3 :.WA~LX~IWJ

\ 1' : / .'' C&-fb c


., 24 I IuU1-1'1.~fI11f::
- - .- FLY t
-
Slxtt: l i p p ~ v v i ~<Iffv.i:\l

IIU. Sourcing tba


ly xil:l;:Al.:>p&~

RC~&- Revicw~CoordlnationlOparations Section Only)


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-
, A ,*.. nDf.qloG.~rs ~~r~,trtnctwern
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L,J q 1:avicw l.7; f.-.J (lltcc~~
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~fi IJ ~ 1 1 i - !.:I *:id ~ w t m ~ n l
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I:( Ollr~C.cr*dNr*ioc~ ny:
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5; .-3 0 .-+5
A:wignc5d:
tl:<I(:/Tlr~~c nssifirtcd-ltr: 1 ./ cdhtrt

ItT: Statcmexrt of Work (OperirUon6 Seotios Ody) w

01'A Ai;l irtrt Offiu-1.: 24 tzuur Ftionc: FAX n


P'ISMA Pn)jr.cl O[Tict.r: 24 hour Pl~orlc: FJpl I
/ Sh~.c~rtcnt
Io::tific~alir~c~ rtl' Wt11.k:

5sl111~ntrvl IMt+:
<.:rrtnn~rzLic~ti 1 CvsL F-*lrl~mtr:
$. Action Taken ( O p ~ r a t i o n sScction Oniy)
1u:u~*ti f 1Erjcakl [1 AUOVI~I;~MO
~yrrtv
C:~mals~.?Icd
vl4h A M )
.
-
b G , 5 p ~5
I -
ACTION REQUEST FORM
I. W h o is Requesting Assistance? (Completed by Requestor)
d 6 br~~ ' 0 7
ke4ucstor Narnc/Titls/Statc: 1) 1 e w ,-,5 (7 e-r? Temporary Phone/ Fax If.

IPermanent phone! FAX W:


-

Requestor Organization: 0 1 {. c3 c i ; f' E-mail:


XI. Requested Assistance (Completed by Requestor) 0 sec~rtxhed
Description of Assistance Requested:

-
L -

Quantity: 0 : 0 11.t- 2 w e sustaining


m
3~ l g h 4 Medium 5 NOmal
Delivery Site Location:
- /,)E&?RL~'PCJS,LA .
-
~ i t e ~ 0 ~ : 3 a 3 M0 d )$$:
u v\\oat&m 24HourPhon .cAX#
7orr?,

State Approving Off~cialsignature: Date:


111. Sourcing the Request #eviewl~oordination (OperationsSection Only)
cloawtlons 0 Procurement
a 4Revlewby:
I
0 other (wan) lnteraww 4-nt
OtherCwrdkMUonby. C1-s 0 bfkslar
0 Other~oordlnatlonty:
Othercomdinetlonb~.
'
Immediate Action Required: U 0 No Action request C] €SF C:
Date/Time Assigned: assigned to: Otha:

N:Statement of Work oper rot ion^^ Section Only)


OFA Action 0ffice-r 24 hour h o n e : FAX#
FEMA Project Officer: 24 hour Phone: FAX#
Justification / Statement of Work:
LmP &,!I"/ &Z m~ow.rre merge we^ S ~ La-e-?
L I

7;r'e #p- Cct95 y6~ '5m~irc7. /bZc

Cost Estimate:

z-.~. # a 1653 =
TRACrXUNQ IHFORMATIOK (pE116A ,USEo ~ ~ ~ : ' t $ $-;;.:;i;;{~ - $ @
:.;.,:,.;~I g; -2: :><:*I
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,
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,-. -L ...: .;. t,.: - .-
, - ........ ..:-:
d., -
CAPSINEMIS Task ID:
9ction Request # l~eceivedby (Name and Organization):
)I.

-
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ACTION REQUEST FORM o m NO. 1660-0047


Expries November 30, 2007
I. Who is Requesting Assistance? (Completed by Requestor] 1 h K "l/3
Requestor Name/T~tIe/Stat~: 5 X, $ < --[ (I
- Temporary PDonr/Fax #L
Permanent Phone: / FOG flfl-2.- FAY#: -

Requestor Organization: sd, a


11. Requested Assistance (Completedby Requestor)
fl oed'
-- --
-
-P -dached

Descnpbon of Ass~stanceRequested:
fl osgc 0 cJ* df
-
-
Juantity. -- honty: 0 0 z ~ l f esustainlnp
i- = &3 ~h
I LJesav~lg
a 4 Medium 05 N-al
Date/Time Needed:

Delivery Slte Locauon:


cxX & v \ n,b/lc fleF;-y
aoo s.(;8 f i r t r c r - rl .Jwe- -

;ice POC: /,A


-
p ry T , q_c,v. %(', 24 $@urPhone: FAX #
f 'L
%ateApproving Official signature: Date: fj&#5"
11. Sourcing the Request - ~ e d e w / ~ o g r d h a t i o(Operations
V
n Section Only)
7 OPS Review by: - OanaU- D Procurement
3 Log Rev1e.w by: 0 Other (ocplaln) Interagency Agreemefit
1 Other Ccordlnatlon by: ~equkitiom a Mlssfon Assignment
1 Other Coudlnatfon by:
3 Other CoordlnaUan by:
nrnediate Action Required: U Yes 0 No Action request NF I :
late/Time Assigned:
-- - - - - -- - -- -
assigned to:
- -
0
-
Otlm
-- -- - -- - --
IT: Statement of Work (OperationsSection Only)
FA Action Oficer: 24 hour Phone: FAX#
EMA Project Officer: 24 hour Phone: FAXU
lstificauon / Statement of Work:
0

?timatedCompletion Date: 1 4osi Estimate:


. Action Taken (OperationsSection Onlvt
ACTION REQUEST FORM om NO. 1660.0047
fipries Novrrnber 30,3007
I. Who is Requesting Assistance? (Completed by Requestor) EoC hfi 4x4
8 t &GPM C i
Requestor Narne/Title/State:

yermancnt Phone

-
l~esuestorOr~anization:
*c- f Temporary Phone/Fax

FAXU
E-mail:
-
#:

1. Requested Assistance (Completedby Requestor) 0 *AM


Description of Assistance Requested:

8% uost
LS- ~ r fyu [ / - ~ i z e $#pucks 1 r c S p : d J P g e ~jp4;lep.
~tOJ
L
-
-
---
---
Quantity: Priority: 0 r Liesaving ~cjresustaming Date/Time Needed:
IS /r-- 3 3bh 4~edium • stemnd &S4P
Delivery Site Location: S -t; aer r$ S 8
fi Q
-
-
3 C a u r F I r o ~ s e5% -

C h a l m e ) f . e . ~ / $ 70093
Site POC: 24 Hour Phone: FAX #
State Approving Official signature:
c
(111. Sourcing the Request - Review/Coordination(Opratfons Section Only) I
a- Dhocurement

Ow(*) 0 ~ntersserq~ s r e m m t
Other Coordlnatlwr by: 0- n~~ss10nmenl
C] Othw Cwrdlnatbn by:
0 OUlerCwrdlnatbnb":

Immediate Action Required: U Yes a No Action reguest C]I Enr:


Da t e / T k Assigned: I assigned to: 0 me^

W : Statement of Work (Operations Section Only) -


OFA Action OfZicer: 24 hour Phone: -
FEMA RDjcct Officer, 24 hour Phone: -
lustification / Statement of Work:

&'WE- /
ktimated Completion Date: ( Cost Estimate: tat mtfi&-
A~t(uotrJ~i
r. Action Taken (OperationsSection Only) A k/Rrnq

:APS / NEMIS Task ID:


:tion Request #
ogram Code/Event #: 19tate:
.
.
j~eceivedbv lNarne -
and ~rrranization):
I~atej~im e
Submitted:
I F
ACTION REQUEST FORM (Interim draft as of 6102)
sR e q u e s t t q Assistance? (Completed by Requestor)
I. Who i
estor Name/Title/State: washington Temporary Phone/Fax #:
. .

anent Phone: h FAX #:


Requestor Organization: E-mail:
II. Requested Assistance (Completed by Requestor) C3 see Attaohed '

Description of Assistance Requested: 1 -


1 trailer of tarps mixed as follows: 2000- 12x12; 1000- 12x15; 1000-12x20; 1000 10x10.

E3oCggalusa and Franklinton sites to provide both manpower and equipment to offload 1 / 2 trailer each.

Interagency Agreement
Other toadloation by: 0~ i i o ~ssinrnent
n
~CoadiMtlonby;
OUlerCooFdinatlonby:

Immediate Action Required: U Yes 0 No

Support relief effort for Hurricane Katrina


----*

,*+ ACTION REQUEST FORM (Intcriln draft as of 1 / 03)


I. W h o is Requesting Asslutancc? (Completcd By Rcqucstor) P*&,
1 .'"
.,,,a /$-$
f&,?--

I<I:I[UC?!;II.II~ ~ ~ I ~ [ ! , ; I I L I : < ~ I ( I I ~ ~ I : IiSI: :l:l : :I li1i.1~1:


-
1'. Requested Assistance (Completed by Rcquestor) l-'-l ?;I.:<:ANiiCIrt:cl

lIr:;(:ri1>rion 111. r\>;?;i:,t;113t:1:. I?(YIIII.XI 1x1:

~ - - - -~
~-
. .

! ~ l Approvi~i!;
a ~ ~ (:)liit:1:.11 sij:11:11I I rt:!. 1)ali::

111. S0,urcing the Rcqucst - RevicwjCoordination (Operations Section Only)


n~waqlnn:.
n-/&Revlcw by:
U ~ ~ ~ ' ~ c vby:
icrv
as

/
,--
1. - -._..-.
U t)rht>r (i?xptaitt) I-! I
PI~I<~.II':~TI~:II~

Intaag-l1cy ngrt?c~nel\r

f;.l i>ltlt:r ( : ~ o r t l l ~ l . ~ ~
1)y:
lci~~ Rcyui;iliu~~.; 1
11Mi%;tjn A~:,lrjtll~rcv~t
I::I Orher Cmrdm,~nonby:
[I 0!11cr Mh'dinJl\an DV:
.

I I I I I II . I I 1-1 YCS l-l NU I-c~~LII::;~;;1:


,\~.rir~r.t GI: $:

l : l : i ~ , c / ' l ' i ~ As:..I(;~I~-:I.~:


~~~ 10:
~I:~:<IKIIC.:I.~ (ltllt:~':

IV: Statement of Work (Operations Section Only)


OVA Actioil Ofliccr: :!a hac.ir I'honc: J'ILXR
FEMA P r ~ > i r ~ :Cj1'iii:irr.:
t. 24 I-tour F'twrl~:: I'ASI!

, V. bction Taken (Operations Scction Only)


(2~ c j c c ~ c t ~ [I'JA1~1:1~11~111~+lit~~
l~'Vti~l~~~tW

AKP - Uclx-is 1-50


^. ^ ,. - - c h
a 002/004
33 104 :2005 0 0 00 FP (
387 -L
2;;'
( ,r~ 2: 2 1-;
ACTION REQUEST FOFUM o m
NO. 1 6 ~ 0 . 0 0 4 7
Exprlar N o w m b u r 3 0 , 9 0 0 7
I. Who is Requesting Assistance? (Completed by Requestor)

L'cj rn;lnrnr Pllone.


I - - FAX fl

Rcqu~:srorC)rgnnlzrition. (
J
,I$ 1 '.'
;: ,: 1 . ,I: I(
1
I*

E m:i~l -

11. Requested Assistance (Completed by Requestor) n FC nn~chcd

.. '. 1
>
: { t , i . q \ \ ,I",@. -
Si1.e POC: n?,,;;:( f'r\;., ::': i. 24 Hog F'hhe: -r;'/ucU
/

Scale Approving bffieial signature: Dare.: 9 - -3 ~i,,s


-.

HI, Souiring the peguest - Section O d y )


o ~ \ ~ a r v ~by:
ew 0 +!, , w z r l e h nDonations ~r(lcut.etnent

n 1.9
Rcviaw by:
il
U (explain)
mtler lntcragoncy ~greemcnt'

0 Otlrcr Coocdllradon by: l(prlol5(llanr nlsslon ~r.gynrncnt


a otrler Cwrcilnatlon by:
Cj Olhcr Cocrtlinatbn by:
Imrnediiktc Action Kequil cd: 1.J YcS 0 NO Aclirrn rcqucst [Zl ESF P':

1V: Statement of Work (Opemtions Section Only)


OPA Action Ofriccr: 2 4 h o w Phone: tttV(#
FEMA Projccc Officer: 24 hriur Phone: FLY#
Jusriricntion / Yrnrenicnt at Work:
' Lo
2 9-

Estitni~~cd
(:ornplction D~tc: I Cast E:irirniitct: - I

a v y
rC
V. Action Taken (Operations Section Only) I f
--
I.. .] Accapmd 0Rrriected

TRACKING.'MFORMATlON[P'EMA USE ONLY)....:..'::..::;~'


::i . :. . .... :. 1 ' . . _,. .._ ... ...- .
. -
S ' .

cChrlS/ NEMIS Tic~k10:


i
Action Request # ( ~ c c e i v e dby (Nan~rand Organizatinn):
Prognan CoclelEvenr H: !state: I ~ a t e / ~ i r nSubrnittcd:
r:

FEMA Forst 90-136, NOV 0 4


1
ACTION REQUEST FORM (Interim draft as of 6 / 0 2 )
I. W h o is Requesting Assistance? (Completed by Requestor)
uestor Narne/Tirle/State: Washington Temporary Phone/ Fax #:

IC FAX #:
Requestor Organization: E-mail:
XI. Requested Assistance (Completed by Requestor)
Description of Assistance Requested: 1 -
1 trailer of tarps mixed as follows: 2000- 12x12; 1000- 12x15; 1000- 12x20; 1000 10x10.
Deliver 1/2 trader to Bogalusa Industrial Park,41 1 Industrial Parkway, B o g a l u ~ LA,
Drop last half at Rutler Rex Bldg.. 108 9th Ave., Franklinton, LA 70438.
Bogalusa and FranWlnton sites to provide both manpower and equipment to offload 1/2 trailer each.
NOTE: IF SHIPMENT REFUSED FOR ANY REASON, DELIVER LOAD TO HAMMOND REGIONAL STAGING AREA @ J C PENNEY ST
2000 SW RAILROAD Y E . , HAMMOND, LA. PHONE
Quan tiry: - .& -
-- Priority: 0!
r- . I Life sustaining Date/Tirne Needed:
5000 tGS--z- 0 3Wgh 4~edium 0 SNormal ASAP , . s/9/2oOS

Delivery Site Location: -~


1/2 trailer to Bogalusa Industrial Park,41 1 Industrial Parkway,Bogalusa, L7f;,the other half trailer goes to .

Other Coordination by: C] Mission Awlgnment

Other Coordination by:

Support relief effort for Hurricane Katrina


'1
b

I.
I

Rcqucsto~NdmejT~tlelStilte.

Requestor Organization,

Descr~ptionof Assistance Requested:


0
GIpl

7'Le;i- (51,
bv Reauestorl
11. Reauested Assistance [ C o m ~ l e t e d
-,
ACTION REQUEST FORM
Who i s Requesting Assistance? (Completed by Requestor)

-
-
Tc~nporawPhonejFax

FAX #:

E-malS
c
o m NO. 1660-0047
Expries November 30, 2007

w,
,

--
;

Quant~ry Pr~orlty
z -. .-
-- 0 3 H~gh
1 L~fesav~ng
4 Medbuin
.0 5 Normal
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slte ~ o c ~ ~ ~ - 3 ~
~ e l l v e r ~ fim
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, . ,ly ~ 3 e I

Site POC:
/ /
/ /A 24 H& Phone.
/I //
- FAX #

State Approving Official signature:


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111. Sourcing the Request - loperations Section Onlvl
1 OPS Review by: 0Donations 0Procurement
7 Log Rev~ewby: 00ther (explain) 0Interagency Agreement
7 Other Coordination by: Requisitions 0Mission Assignment
7 Other Coord~nationby:
7 Other Coordlnatlon by:
rnmediate Action Required: U Yes No Action request ESF B:
ateJTime Assigned: I assigned to: Other:

IV: S t a t e m e n t of Work (Operations Section Only)


OFA Action Officer: 24 hour Phone: FAX#
FEMA Project Officer: 24 hour Phone: FAX#

- --

Est~matedCompletion Date: Cost Est~mate:


V. Action Taken (Operations Section Only)
I [7 Rejected
Accepted 0 Accountable property
Dispos~tion: Coord~natedwlth APO

Action Request # Received by (Name a n d Organization): , -

I
Program CodeJEvent #: State: I~ate/~im
~ubmitted:fl)fl/o5
e
I '
&;/$#
r
1 Ortginated as verbal

FEMA Form 90-136.NOV 04


"*"*
i
. ,"- - ."-x%
. -.- - - -
ACTION REQUEST FORM (Interim draft as of 6 / 0 2 )
.
1
-
W h o is Requesting Assistance? (Completed by Requestor)
h s t o r Narnr/Title/Statc: Washington Temporary Phone/ Fax #;
I
Requestor Organmtlon.
FAX #:
E-mal:
I
11. Requested Assistance (Completed by Requestor) C! see Attached .
Description of Assistance Requested: -
1 t r a l e r of ~arpsmuted a s follows. 2000- 12x12, 1000-12x15; 1000- 12x20; 1000 10x10 1
l ~ e i i v e r112 trader to Bogdusa Industrial Park. 41 1 Industrial Parkway, Bogdusa, LA I
lDrop last ha!{ at Rutler Rex Bldg., 108 9 t h Ave., Frankllnton. LA 70438. I
I Bogalusa and Franklinton sites to provide both manpower and equipment to offload 1/ 2 trader each. I
/NOTE. IF SHIPMENT REFUSED FOR ANY REASON, DF.1 rllcDLOAD TO HAMMOND REGIONAL STAGING AREA @ J C PENNEY ST
2000 SW RAILROAI) AVE., HAMMOND, LA. PHONE
Quantity
5000 t&%s-s
- - Prlont~
I3
G
3 Hgh
I uresawng
4 Medium
2 ufe sustaining
5 Normal
Date/T~meNeeded:
ASAP , 9/9/2005

I 1/ 2 trailer to Bogalusa !ndustrial Park, 4 1!Industrial Parkway, Bogalusa,-&A; the other halr trailer goes to
- I
IS ~ t POC: Rutler Rex Bldg., 108 9th Ave., Frankllnton, LA 70438 -
I
e Lt. Tommy Mlnank 24 Hour Phone FAX#
1
State Approv~ngOfficial signature:

HI. Sourcing the Request - Review/Coordination (Operations Section Only)


OPS Revlew by Donahons [71 Procurement
Date.
I
Log Review by' Other (explain) C! Interagency Agreement
L1 Other Coord~natlonby fi Requ~sltlons C Miss~onAssignment
Other Coordlnat~onby
I Ci Othcr Coordlnatton by:

Ilrnrnedlate Acflon Required yes No Actlon request ESF #.


I ~ a t /Time
e Assimed: I assigned to: Other:
---- - - -.

IOFA
tatement of Work {Operations Section Only)
Action Officer 24 hour Phone: FAX#
7
FEMA Project Officer. 24 hour Phone:
Justification / Statemenr of Work.

Supporr 1 elief effort for t Iu -rlc.wr kati lrl,r

-
Cost Estimate
=
--

Ccurdlnated 1 ~ 1 t h9PO

-~--

@rogram Code/ Event r;:


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I ACTION =QUEST FORM 7-..
NO.
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J G(i0 0047
---,-.OM.U-...-......-..
1. W h o is Rcquc?rling Assistance? (Completed by Rcqucstor)

11. Requested Assistntlcc (Completed by Requesror) C-j re,:.4Lc~,,;n.!l,:tl


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1V: Statement ofWork (Operations Section Only)


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KEhlA F o r m 90.136,NOV 04
. 08/30/2005 11.59 F A X

/
- ACTION REQUEST FORM OMB NO. IL~~O-OO':~
Expvins Nouornbcr 30, 300 7.
I. Who is Requesting Assistancc? (Complctcd by Rcqucstor) c4 ; ~ h - - 0 32.
. . / i l / -.
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V. Acti011 Taken (Operations Scction Only)
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I:EhlA Form 90-13s.NOV 0.1
,

'08/31/2005 14:28 FAX 225 9 2 5 7501

ACTION REQUEST FORM o m NO. 1660-0047


Expries November 30,2007
I. Who is Requesting Aqsistance? (Completed by Requestor)
%T. L h b l c ~ &&
~~J J ~ ~ ~ c Temporary Phone/Fax ii
-
FAX #.
, .

11. Requested AssisMnce (Completed by Requestor) a see~ltached

Description of Assistance Requested: C) I ( \ ~ C , L L %<Le - G 31zc

uanrity:
\ o o --
-
-- y Priority:
a
0 1 ~ifesavmg
3 High 4 Medium
2 Lie sustaining
a 5 Normal
Date/Tiqe Needed: .

-
Delivery sit=~ocation:54. CU LL-S TIUZ\ &s9 ThL
-
-
4

10 5 1 7-L &ALLAQ~~-;>- -
, U A U M J I I - ~ ~7*357-
,L~
Site POC: FAX #

Date:

~ C o o r 4 & , ~ $ i o n , ~ Q ~ SectSon
~ ~ t i o nOnly)/
s
"- 0 ~onatlwrs
0 ~ o ~ge v i e wby: . . .. ,, 0 Other [explain) 0 lnterasency Agreement
0 Other Cwrdlnatlm by: t i .a~eq~slllona 0 Mlss\an AAdgnment
0 Other Coordlnatlm by:
Other Cwrdlnaflon by:

Immediate qctiop Action request 0 Euj:


7

OFA ~ c t i &bfficcr; 24 hour Phone: FAX#


FEMA Project Officer: hm 2 4 hour Phone: q ($/FAX#

-
Sst~rnatedCompletion Date: ) Cost Estimate:

-
I. Action Tgkep (Operations Section O 4 y )
Gepted Rejected
0 Accountable P t o p e q
,isposition. Coordinatcd wrth APO

R A CG~, , * . ~ o ~ ~( P
F '.
oEN~ : , U S EONLY-@ ; :.! :;2;.z$<+~&$~j~.i;$i!<+~;~f+~+;~
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~~~~~:
. . , .- ? F a ; .
lAPSINEMIS Task ID:
:tion Request # i~eceivedby (Name and Organization):
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-

ggam Codc/Evevent #: [state: I~ate/~irn e


~ubrnitted:&?p/~~
I u o d p i n a t ~PS. vrvubd
J
:MAForm 90-136,NOV 04
I
.

t hon -
Who is Requesting Assistance? (Completed by Requestor)
*

4 --
-i
Requestor Natne/Tltle/State. k. _3 c & i ~ e , - ,

I ~ r r m a n c nP

Requestor Orgnnrzatlon k.- :x - & r - $ ~ ~ n .


11. Requested Assistance (Completed by Requestor)
Dcscript~onof As?tstance Rpquested.
C%g

E (j 4 ,Ahr eg A',
k! 0 5 T-

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4
-
1
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'T'crnpordrv Phone/Fax R

FAX #.

E-mail.

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-
Expries November 30, 2007
F&d Q&*QX$

see ~mched

Qudn~~ty
-
Prlorlt~ a I bfesaving 0 2 ~ l f esustalntng Date/Ttme Needed.
rCRse$ -- @ 3 HQh C! 4 M&um 5 S Normal 8 1 ~ 3 i?:?c:
~
Defivels L C Lj 2 3 G +)n L mcz g\ . I
m & t a I f r ~ l ~7A0 a o ~ -

FEMA Project Officer: 24 hour Phone: FAX#

I
Justificat~on/ Statement of Work:

Estimated Complehon Date;


V., Action Taken (Operations Section Only)
%ccepted
Dlsposltion.
a Rqected
05 &wbc-o'
1 Cost Estimate:

Accountable Propem
Coord~natedwith APO
I
eCAPS/NEMIS Task ID:

Program Code/Event#: Date /Time Submitted: 0 ~riglnatedas verbal


F E m F D T90-136,
~ I O V 04
-

--
- --. ---
,'
UZtile sustaining
Quantity:
Ic
- Priority:
0 3 High
t ~ifesavlng
a 4 Medlurn
-
-
'
5Nmal I
Date(Time Needed:
$f 138) 23c
Delivery Site Location:
set fi-tt-&Led. 4

t i o n Request x Received by (Narne and Organization);


ogram Code/ Event #: State. ~ubmittedfl/$~&-
I~ate/~im e
- z . p 1~a originated asverba~
I
MA Form 90-136,NDV 04
08/31/.2005 2 2 : 26 FAX

I ACTIQN W U E S T FORM OMB NO. 1660-0047


Exprier Navcmbcr 30,2007
. W h o i s Requesting Assistance? {Completed by Requestor) E@L Qk5 144
N a r n ~ / T ~ t ISe f ~ C :
bcqUCstQr c . \ , [i.*ten f Temporary Phone / Fax #:

rmanenr Phonc.

~ 9 ~ e s organmuon:
t o ~ ;y ; s+.,,p E-mall: -

11. Requested Assistance (Completed by Requestor) 3 see ~ t t l ~ h c d

Descriphon of Assrstance ~ e ~ u c s t r ~ -F& Kc,-


8 - I.?. g
L / ~-7~ \ -
Q u a n u r y a Xtumzyd pd4cs Prionty: r lir="iq 0 2 we ~ustam\ng DateJTtme Needed:
W ~ J L F-+a .
Ik4 r fi 3 n~gh ~ZIQ Medi~m (3 5 Normal 3 ?730

I
b
-
elivery Slte hcatm+. Fy-ccck c c # fe tr, c.It X L J qn
c5 t4 +?,Lr;li b
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Wil \

FzP~c..C?S.&falne,,-+,iq
ite POC: d-o~f3R[f,37'rJ
State Approving Official signature:

nl. Sourcing the ReqUest -,~ e v i ~ w / ~ o o r k d a t i(Operations


on Section Only]
rja 0% ~+3"ewb: pthL 4,:@&&fi- If D M ~ U ~ S ~rmrcment
3 ~ c qRevlew by:
-
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a Omer (expialn) a Interagency Agreement
0 Other Coordination by: a Requlsmns a AssMnment
~lssion
0 Other Coadlnatlon by: 1
0 Wler Coadlnation by:
Immediate Action Required: U Yes 0 No Action request a EY I : 1
Date/Time Assigned: 1 assigned to: 17 mer:
N:Statement of Work (Operations Section Only)
OFA Action Officer: 24 hour Phone: FAX#
FEMA Project Officer: 24 hour Phone: FAX t
Justification / Statement of Work:
...

-
I ACTION REQUEST FORM oddlip NO. I 660-00+7
&pries November 30, 2007
. who is Requesting Assistance? (Completed by Requestor) a&
eguestor N d n e / T l t k / S t a l r ' ekl'l $!%% & C Temporaty Phone/Fax ff.

-
Permanent Phor-I FAX#

questor Organizat~on: E-mail -


. Requested Assistazxce (Completed by Requestor) see ~ttached
scriptroil of Assistance Requested
-if; <!. i *i.
p ;pp ' cGT &S' ?J+?S2 - 1
;

Quantity:
-
Priority: 0 1 Lifesaving a 2 bife sustaining Dare/Tlme Needed:
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,
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I-/ FAX #

State Approv~ngOfticla1 slgnnture Date :.I L ,**, C


1

IIX. Sourcing the>equ_es@~eview/~~~rdbation(Operations Section Only)


EI 0 ~ ~evie.
s by: Danatj~~ 3 Procvrement
0 Log Revaew by:. Other (explam) a ~nteragenqAgreement
0 Other Coordination by: 0Mtsion Assignment
m Other Coordination by:
a Other Coordtnatlon by:

(mrnediate Action Required: U Yes NO


Date/Trme Assigned: I assigned to: a Other:

IV: Statement of Work loperations Section Only)


OFA Actron Officer: 24 hour Phone: FAX#
'FEMA Project Officer: 24 hour Phone: FAX#
Justificatron / Statement of Work

Estrrnated Completion Date. I Cost Estimate:


V. Action Taken (Operations Sactlon Only)
0Accepted a Rejected C] Accountable Property
Disposition. Coord~natcdx v ~ t hAPO

CAPS / NEMIS Task ID:


I
i ~ e c e i v e dby (Nameand Organ~zation):
Istate: / ~ a t e / ~ i m~ubrnitted:r/$//07/
e fl/ddg 10 originated as verbal
1 I
'
1
FEMA Form 90-136, NOV 04 >
ACTION REQUEST FORM o m NO. 1660-0047
Expriea November 30, 2007
. Who is Requesting Assistance? (Completed by Requestor) 041~73

e r m a n e n t Phonc. FAX #. -

l ~ e q u e s t o Organization:
r E-mail:
1. Requested Assistance [Completed by Requestor) B/See Attached
Description of Assistance Requested:
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>

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Quantity:
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--
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-
.
.--*
PrioriN: 3 1 Lifesaving
El 3 nigh d MeQurn
G 2 ~ t f es~istaining
@ S ~ormsi.
Date/Tirne Needed:
L Tf,,fl
-

Dellvery Site Location: <>,- .;: ,,&I , ,*-VV c--. . -.

2.z p-2 p \ 3 * d r : < i.-!&


7 --
. . i L-.4 7 i30 5

Date:, .<* ;-cp 3 1


'
III. Sourcing the 8equp.st Review/Coordination [Operations Section Only)
@ OPS Review by:-- C] ona at tons
--7-
Procurement

G Lob Review by: flOmer (explain) 0 InteragencyAgreement


D Other Coordlnatlon by. a Requlsitioos 0Mission hslgnrnent
O Other Ccwdlnation by;
0 Other Cwrdination by:

Immediate Action Required: U Yes 0 No Action request a €SF #:


Date/Time Assigned: assigned to: Other:
IV: Statement of Work (Operations Section Only)
OFA Action Officer: 24 hour Phone: FAX*
FEMA Project Officer: 24 hour Phone: FAX#
Justification / Statement of Work:

L
Estimated Completion Date: Cost Estimate:
V. Action Taken (Operations Section Only)
@ Accepted 13Rejected 0 Accountable Property
Dis~osition:

/a

FEMA Form 90-136,NOV 04


' - 09/01/2005 14:3 7 PAS

ACTION REQUEST FOFW oara NO. 1660-0047


Expries Novedx?r 30,2007
I. s Requesting Assistance? (Completed by Requestor)
W ~ iQ 2 494 /izd
_+

Temporary Phone/Fax #.

Requestor Organlzaaon. e- iq - 0 -f E-mall:


LI. Requested Assistance {Completedby Requestor) 0 ~ e Attached
e
Descrl~tlonof Assistance Requested fi fi ,A \ r). h Ce , L, 1 LVC, t D ,, .< -

/'
- Priority: EZ
csfe swtalnmq Date/T~rneNeeded:
5-2
- - C] 4 Medtilrn G 5 Nomal

.--
Site POC: 24 Hour Phone: FAX #
State Approving Official signature: Y.t' Date:

Uinteragency Agreement
a Other Coordlnatlon by: I Requldtlons 0Mission wstgnment
0 Othw twrdlnatton by:
Other CmrdlMtlon by:

Immediate Action Required: U Ye5 a No Action request a ESF Q:

DnteJTimc Ass~gnad: I assigned to: 0 other:

N: Statement of Work (Operations Section Only)


OFA Action Officer: 24 hour Phone: FAX#

L
Estimated Complet~onDate: 1 Cost Estimate:
V. Action Taken (Opexations Section Only)
D Accepted 0ReJecCed 0 Accountable Property
Disposition- Coordrnatcd wlth APO I
r a t
ACTION REQUEST
- FORM o m NO. 1660.004 7
Expries Noucmber 30,2007
I. W h o is Requesting Assistance? (Completed by Requestor)

11. Rcquested Assistance (Completed by Requestor) i-2 ECAlMEnill

(~u~lnrity: 2 . . . .+..,.-- Priority: ? L I ~ Crustamtng


4<+,7b.c;;? 6-6 0
&A.
.. -
..--

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SiLc POC: 24 Hour Pho\nca - .FhXlt.

Stulc Approving C)flicial signature: , ,


,,,2:~c'~ ,. i , . ! "." '..
\..,:..
.*"/" Dii tc: 9/,:A,: ..;..,,.'.;.
111. Sourcing the Request - ~ e & e w / ~ o o r & a t i o n(Operations Section Only)
(11 01%nwtaw by: :
$ld,h !: $,,j :b 13o~nntims IJ ~,t.~unment
0 I*) R<Wll?w l)y:
,I
0~ c (cup~a~n)
r n\ntcr.ilgcncy ~ g r w m m t
~r ~cor~01wtlon
by: Rcq~lSltions MICjilm 1\66i!)rln>e1~

0 m c r Coordlnaaon by:
0~lt.rCOordlnatlon by:

lmrncdintc Action Keq,trircd: I-..] Ye5 No Action reqtzcsl €SF I:


Dncc/'l'irltc Assiljncd: :t:;sir;ncd to; iJ oth~v:

IV: Statement o f Work (Operations Section Only)


O FA Action C)lficer: 24 hour Phot~c: FAX#
~ -- -- - - -

FEMA Project Officcr: 2.1 hour Phone: li'AXn


.Justification / Stntcmenc of Work:
p qy
i'\\.w,' ]

Estimnred Co~tlplctiunDatt-: ] Cclst. E>;timate:


V. Action Taken (Operations Section Only)
(3Mccptcd Ryend

~
-..
cCAPSINEMIS Task ID:
,.&s'%,.$*.$% 2,!.%-,G ~.>..~~~>.~~::>:
::;: ,.>..>,:- ..<, ,.;. ..::: ., .:s ,..: .: ..;..

Acrion Requcs~# IRcceivcd by {Narnc and Orguniratinn):


.Pr.o~rumCodcjEvent I: Slnre: 10atc/~irncSl~bmi(lcd: I Onglnated 3s vcrbd
7
FEMA Form 90-136, NOV 04
f ACTION REQUEST
- FORM o m NO.1 660-004 7
Expries November 30,2007
. Who is Requesting Assistance? (Completed by Requestor)

Permanent Phone: FAX #:

[ , j- 1
Requestor Organlzatlon. 3 4' 1, ,/I E-mail.
-.-
11. Requested Assfstance (completed by Requestor) a see Attached

Description of Assistance Requested:


f-:. a* ~n./ c,.. %, -,
ggr <- 1 .,& ,j7/./.,LL c ,.- /vl ,/,T //"-^
'
dCJ.

I-
Pnonty. 0 i wesavtng 0 2 L~fesustarmng DatcfTune Needed:
0 High 4 Medlum 5 Normal

I
-
Site POC: 24 Hour Phone: -
-- FAX#

tate Approving Official signature: .-


111. Sourcing the Request - ~ebiew/~oo;dination(OperationsSection Only)
C9/ OPS fkvkw b y . a t L q , - 0 ~anauons 0Procurement
U
- Log Revlew by: d -
U Other (explain)
-
UInteragency Agreemwt
0 Other CoadlnaUon by: ~equlsltlons MWm Asslgnrnent
a Other Coordlnatlon by:
Cl mer C O O ~ ~ I ~by:
~UW

Immediate Action Required: U Y e No IAction request €SF I : 1


DatelTirne Assigned: f assigned to: a 0th-

IV: Statement of Work (Operations Section Only)


OFA Achon Officer: 24 hour Phone FAX#
'FEMA Project Officer: 24 hour Phone: FAX#
Justification / Statement of Work:

Estimated Completion Date: I Cost Estimate: 1


V. Action Taken (Operations Section Only)
O Accepted CI RejMed [J Accountable Property
Dispositionj Coordmatcd with APO
RevW fi~pfl *m
g k p 07 05 09:07p St. L u c i e C o u n t y 703.321. 1 1 1 1 P L ~ .- -.

.. 7

f
I-
-----' ACTION REQVEST FORM
W h o is Rcguceting AssiotPncc? (Completed by Requestor)
Rcypc:slttr. Nt~~tu:/l'illc/SlkIIc:

Pcrrp:tncn t Phanc:
. . -
6. h c ~d ~ ~ j w
.
Ti-mpm:71?; Fl\c~~re/P':~x

inx r
#:
o ~ NO,
+/7- L
a ~660.0047
Exprlas N o u m b e r 30.3007

Dare/'fimrt Auoimrcd: 1 ~~snirsncd


to: 0 o w
JV:Statement o f Work (Operations Section Only)
QFA Action OlIiccr: 24 hour Phone: PLY#
FPMA Crujccl OCIiwr: 31 hour Phonc-: FkYU I

E t i l i r ~ r u ~ rCdU I I I ~ ~ C ~
D~ILC:
IU~I 1 1:(1c1I?skirnc~~c:
V. Action Takcn (Operations Section Only)
UrxcEOtcQ
oi3pmition:
URCJwkd
6 4 6alh~~ng +e[d ~+-L!IYI
ncravnrnbk R
-
CerJsnn~rrlu.uh aYn

GS& %I( 5bUcihq %e 5k~K.5 I

I
-Ac:~ic*nr\c~tuc%L# iAc.::c~vcu(by {Name onri O,.@::iz:ctiurr):
1 IU UIQMW a s w W
Pwgrunj Curlc./Evrnr I/:

FEW Form 90-136, NOV 04


Sc~tc: - ~ a r e / ~ i mScu b ~ ~ l i ~ ~ c r l :
.
r

I.
R : a

Pel tn,lncnr Phone

Kcqucutor i)ryanimtion:
:

\:< :!
-
W h o is Requesting Assistance? (Completed by Requestor)

L
-

.
II. Requested Assistance (C%mpletedb y Requestor)
Dc::cripcion 'IT Assistance Rcq~arsted: ,, 1
&.:-, ,\
i ,

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ACTION REQUEST FORM

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0-

'rcrnponry Phar,c/F;u I f :
NO. 1660-0047
386-L
Erpdar N o ~ m b a r30, 2007
2s,xk~ew- ,%/!-)

E! *;erattnmcd
*

1V: Stntcment o f Work [Operations Section Only) ,


OFA Acrion Ofliccr; 24 hour Phonc; FAX0
FPMA Project Officer: 24 hour Phone: FAX It
Justification / Str:ttcmencaf W13rk:

Escin~nredConlpler~onDatc:
1
1 Cost Est~rnste:
8
14b
V . Action Taken (OperationsSection Only)
/a Ncepled Rejcacd lo ~rotlnt3blcProwW
Coutdtnetnti wtrh h1'0

LOG

TRACKING INFORMATION (FEMA USE ONLY). ,.


cCAPS/NEMlS Task
Action Request
P r o g h m Code/Evcnt rl;
#
ID:
"-. :.. .i
. ., .
. ..

Reccived by (Nnmc 3 r d Organization):


State: Sue bmittcd
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,
- .

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i P

E'EMA Farm 90-136.NOV 04

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'# . 1

1.
i- -
ACTION REOUEST FORM
Expries
NO. I QMB 660-00*7
Nowmber 30,2007
. Who is Requesting ~ssbtaace?(Completedby Requestor) E ~ C - ,214
5 I\L-& , &f .'z k
~ C ~r Temporary Phonc/Fax
L #:

I ~ e n n a n e n Phone:
t - * FAX #:
l ~ e ~ u e s t Organization:
or vkS
&, fa J :s 0 ti. f E-rnaik -
111. Requested Assistance (Completed by Requestor) 0 see A
-
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-
W

I
Description of Assistance Requested:

-- -
Quant~cy.
a wL
Lk'kery Site t r i a ~ n : ,j ;pr
060Priorw: 1 bfesavcng
Hlqh a 4 Me&urn
0 2 Lfe sustacntng
a 5 Nwmal
Da te/Time Needed:

~k S A e r : F C c)FF:ce - --

~ 3 FEeJ
,
--

s i t e ~ ~ ~ : k:,-bq 24 Hour Phone: -‘ .---TAX #

State Approving Official signature: Date:


i
l11l. sourcing the Request #e&ew/~oordination (Operations Section Only)
-
a
I"
0
OPSReViewbyt

Log Review by:


othercoordinatlon by:
/d
c --
Dcnatb-6

URequisMw
0 procurement
0 Inkragency Agreement
UM I S SAsdgnment
!~~
Other Cwrdlnatron by:
0 ~thertoadrnatknby:

immediate Action Required: U yes 0 NO Action request a EY 1:


I~atel~im e
Assimed: I assiened to: Otha:

Ilk Statement of Work (Operations Section Only)


OFA Action Officer: 24 hour Phone: FAX#
FEMA Project Officer: 24 hour Phone: FAX#
Justificat~on/ Statement of Work:

TRACFUNG ]MFORNATIO~(FP;1IMUSE O ~ W : : $ + 1:4:.: - : ;.- * :3 \.:? 2 -.


:,., . ' . *. . _ ..
'*I O .

In.
eCAPS/NEMIS Task
Action Request # !Received by (Name and Organization):
gram Code/Event #: (state: f ~ a t e / ~ i m~ubrnitted@&
e %*&J onpuraEd as
7 / r
PEMA Form 90-136,ROV 04
730C- 3
1
1 ACTION REQUEST FORM o m NO. 1660-0047
Expdcs November 30,2007
I. Who is Requesting Assistance? (Completed by Requestor)

Requestor Organizauon: @-&55~6 aw E-mail:


d

11. Requested Assistance (Completed by Requestor) 0 See Attached

. Quant~ty: Priority: 0 I bfesavkrg Z bfe sudatn~ng . Date/Time Needed:


3H Q ~ 0 4 Medium 5 Normal
- --
--
-- -

l~clivcry sik Location: --Df=C7A~!i bb~ka5 -


A

N w Orz-WJ - -
Site W C : --NY ~ ~ N Y ~ R . D 24 Hour Phone r-bfl~x #

Interagency Agreement
Other Cmdlnat

Other CmdlrBtl~nby:
Otlier Coadlnatbn by:
mediate Action Required: U yes 0 No

- - -- -
24 hour Phone:
24 hour Phone:
-- - - - -
FAX#
ETAX# !I
I
Justification / Statement of work:
m d
A*

I
~- ~

Estimated Completion Date: . Cost Estimate:


V. Action Taken (Operations Section Only)
' a Accepted 0Rejected
- - -

Disposition:

zCAPS/NEMIS Task ID:


4ction Request # l~eceivedby (Name and Organization):
'rogram Code] Event I: /state: I~atef~im e
Submitted: (a
~riginatedas vectxjl

?EMAForm 90-136,IOV 04 c
I -
ACTION REQUEST FORM OMB NO. 1660-004 7
Expries November 30,2007
I. Who is Requesting Assistance? (Completed by Requestor) ex f.?#?'ewk .

Requestor Narne/Title/State:
C
74 q :bnAoa- /(tar,, I
J3 fldller Tern- -PhanejPaxh-
--
-
p r r n a n e n t Phone. FAX 4 d ! -
Requestor Organization: T a qy; pbi04 E-mail: .
- -

11. Requested Assistance (Completed by Requestor] 0 See Attached

Description of Assi tance Requested:


1 L;.+,, o.+ Pun60+gvl. 5 S n r d s a rcdr:u top.

-
-- a 1ufmwng a

-
Quantity. - Prlorlty 2 bfe susta~ntng ,
- t~
I
=
-
__I_ d3 High 0 4 Medium 5 Normal

Delivery S!fe Location:. --


-
2

S ~ ~ ~ P O/ YCo r: y J 3 &/$cr -- 24 -Hour Phone:

IState ~ p p r w i n Official
g signature:
-
#
&
//
-
Date:

111. Sourcing the Reques ination (Operations Section Only)


0 OPS Rev~ewby: Owations n~rocorernent
0 ~ o Reviwby:
g ~ e (explain)
r 0 Interagency Agreement
Other Coordlnatlon by: a 0 isS Son Assignment
0 Other Coordination by:
Other Coordlnatioo by:
Immediate Action Required: U Yes a NO Action request 0 €SF I :
Da te/Time Assigned: I assigned to: 0 ma:
v
XV: Statement of Work (Operations Section Only)
OFA Action Officer: A 24 hour Phone: FAX#
FEMA Project Officer:
,
Justification / Statement o k o r k
- J
24 hour Phone:
A
FAX#

Estimated Completion Date: Cost Estimate:


V. Action Taken (OperationsSection Only)
Accepted Rejected Accountable Property
Disposition: Coordinated with APO

- - - - - -- -

eCAPS/NEMIS Task ID:


I ~ c t l o nRequest # l~eceivedbv (Name and Organization):
- - - - 1I
Program Code/ Event #: Stare:
- -
[ ~ a t c / ~ i r n~e u b r n i t t c d : ~
/
w ~ TO originated
&q5>
f I
1
FEMA Form 90-136.NoV 04
Tf?AazwtrJGINFORnaATloDM (FENIA USEONLY)
Aclion Rtqwst NO. Pmmw ~ ~ v a: ~ c u
3 *rrizd nz xvb.n

Slate bWTine EubNW.

w
Form 90-136, NcXr 04 (This p7&ii
II
.?r form hwn b ~ x uvdnh?~-1
? ks r;ar~l@.tbbkly
I 1
IgJU I J f U C D
*, " J , V D , L V U J " 0 -I0 rnn

1 . '
. .

. - . . ACTION REQUIWST FORM Q~OBNa. .l66O.O(N7


g~p*prls-Norrrrrtlrcr 30.2007
I. W h o is Requesting Asdstancc? ( C ~ ~ m p l e t eby
d Wequestor) -C . , , ,. ., ,1 .. . I.:,-.-. ,..':
,
: .. .
j . . ~ c r I l p n r ~~l y h ~ ,n. ~ ~ / i ~ ~
Prrrrrlir;rcrtc Phone.. FIV( Y: -.
Rcqut:~torOrga1.11hLiun: (; VC VI
.:( I :- 0j\ j_? '(I:-. fi E-.nnr:
IS. Rcqutsted Assishncc (Completedii by RequestorJl;
-
- :
a 'iCeNw
Dcscriptton 01 A ~ s i s l a n c cRcqucstcd:
.-\
i; :
I

i 1'- " . .. . ^
. . 1, ;
'
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f f . : ...

-
,5r rc LY

a. Sourcing the Request & o i z o o . r d i M t i o n ( O p ~ t i o m Section


s Only1
I-
DPm1nrmfQt
P 1-1 InlnxYmn. h m n d

'lmmdL%teAction Rcqrairrd: !-I Y* am Action remtcrt U SF 8:


J

DaLc/Tirnc hsaigr~crl: asaigrtmd to: 0 Ore:

IV: Statemeut ofWork lOperations Gectflon Only)


O F A Action* 0ftir.e~ 24 hour f honc: PAXU -- -
FEMA P ~ j c cO
t fiet: 24 hnur M~onc; FAXU 1
. 1 u s f i i
P A

Estimated Cornpktt~crDnte: I Coal E ~ ~ ~ f n a t r


-
V. Action Taken IOpcrations Section Odly)
Owmm nwlfam
Dtrps~uun:

- --
FEMA Form 90.136, lPOV OI
-
; -(
ACTION REQUEST FORM 0- No. 1660-0047
Exprlsr November 30, 2007
I. Who is Requesting Assistance? (Completed by Requestor) E o - ~DF -
I

Lk. mWncr 5 Q , Temporary Phone/Fax #:

FAX #:

Requestor Organization: C% 6bQe,.hQJ'c, MC E-mail: -


11. Requested Assistance (Completed by Requestor) see Attached
Description of A s a m a n Requested: fife & yao +f?n tS Wi* S',de \;3(-,+c,
a \ * c ~ ~ i \ + '-\O
k CQ+ s fg s e t Up tr;age cegs* Fhc e\(ckcueeL.

Quantity: Priority: &f I bfesavtng 0 2 ~ ~sustainhg


f e DatejTime Needed:
-. 0 3 Hgh 0 4 Med~urn 0 SNMmal
--
Delivery Site Loc5Eoni emd e ~ $ h u \ CW* ?a&,~ \&~ ~ " m s--sht\d I

a Interagency Agreement
u M i s h Asslpnrnent

Estimated Completion Date: I Cost Estimate:


V. Action Taken (Operations Section Only)
, 0Accepted 0Rejected 10 Accountable Roperty
Coordinated with APO
I

eCAPS/NEMIS Task ID:


9ction Request # Received by (Name and Organization):
Program Code/Event #: State. I ~ a t e f ~ i r nSubmitted:
e . 10 gr(g~natdas verbal
-

ZEMA Form 90-136. HOV 04


N ' I
* 3 6s
ACTION REQUEST FORM OMB NO. 1660-0047
Expries November 30,2007
I. Who is Requesting Assistance? (Completed by Requestor) - w-.W
Requestor Narne/Title/Sfate: L/3 fire TQL FO r ce Temporary Phone/Fax # 361
Permanent Phone h FAX #:

Requestor Organizat~on: E-mail. -


11. Requested Assistance (Completed by Requestor) a See Attached
Descr~ptionof Ass~stanceRequested:
Ned 2 SO~SO
T,,+s afid 12 2 0 x 2 +~e m i s .

Quant~ty Priority: 0 1 L~fesavtng 2 tife sustaining Ddte/T~meNeeded:


-.
- 2-($% - @ 3 HQ~I 4 Medium a 5~rmal

b e - t- 1 9 1 3 ; ~ I ~ -~ -- rI .. 1
&A

Del~velySite Locatiloz - & ' e ~ O ~ l e o *Fioe


s .
--
- wek,(Ic &-paod I P - LY
@PA O rje a ~ s
SltePOC. TOMC o l e w a h -
State Approving Official signature: Date:

1111. Sprcing the Request &~ew/~60rdination (Operations Section Only)


a procurement
<

El Donations
0
~ O P Review
S by:

Log Review by:


(A_)
Y L - 0ther (explain) IJ Interagency Agreement
0 Ofher CoordinaUon by: 0 Requisltlons 0Mlsslon Asslgnrnent
Other C~o~dlnatlon
by
0 Other Coordination by:

Immediate Action Required: U Yes No Action request 0 ESF I:


Date/Time Assigned; ( assigned b other:

N:Statement of Work fOeerations Section Onlvl


OFA Action Officer:
FEMA Project Officer:
24 hour Phone:
24 hour Phone:
FAX#
FAX#
I
Justification / Statement of Work:
. . A

Coord~natedwith APO

L
Action Request # Received by (Name and Organization):
Program Code/Event #: State: ]~ate/~im Submitted:
e (0
Originated as verbal
L
FEMA Form 90-136, NOV 04
-,
ACTION REQUEST FORM o m NO. 1660-004 7
Expries November 30, 2003
I. Who is Requesting Assistance? (Completedby Requestor)
3&

Requestor Organization: L O & (# E-mail:


11. Requested Assistance (Completed by Requestor)
r
- -
0 *Attactred
Description of Assistance Requested:
bre.r,~e
&&(it-\ ~ ~ l r ; s - + u;ae d d + y + ~ h3;vrq
p ~ / ; ~ j t s 4 -9
L
Quantity: Priority: ng
..
.
-
w-I&- 0 4 Medium 0 5 Normal
~ e i l v e r ysite toea&.
2-

- A h fin.,, QEP -
---

State Approving Official signature: Date: 3 /+pJ'


111. Sourcing the Request - ~ e v i e ~ / ~ o o ~ h a t i o ~ ~ p e n rSection
t i o n sOnly)
w-
ODCM- 0 ~rocurement
J
Log Review by: 0ather (eXPb1) Interagency Agreement
0 ouw ~oordtnatlonby: 0 Requlslaons C] nrsslon Assignment
0 other CmrdlnaaCn by:
C]I Other Coordlnaticn by:

Immediate Action Required: U 0 No Action request 0 ESF P:


I~ate/~im Assimed:
e 1 assigned to: 0 Other:

N:Statement of Work (OperationsSection Only)


OFA Action Officer: 24 hour Phone:
-
FAX# - - - --
FEMA Project Ofiicer: 24 hour Phone: FAX#
Justiftcation / Statement of Work:
i

Accountable Property
Coordinated with APO

Action Request # Received by (Name and Organization): i


Program Code/ Event #: State: (~ate/~im
Submitted:
e 10 Originated as verbal

PEMA Form 90-136,NOV 04


,$,JVUL,"LU

Y ~ , , V " , L " " J " Y 2 , Ir"'

366
iACTION REQUEST FORM am NO. 1660.001 7
fiprlrw Nowmber 30.2007
' 3 '
. Who t Rtqncsting Assistance? (Completed b y Requestor)
,
,
%

-
'
. * ..k7

Requestor Orgianuuw,rc: L 0//S &p , E .mail:


11. Reqaestcd Assistance (Campletled by RcquesWx) i l r-fitocnnr
2

i m t e d Cumplction Otlte: [ ~ o s t ~htimilre.


t
Actioa Taken (Operations ScctionuO d y l
U~cccvrrcr 0 *!cr?u',rd
Disp?~n~o.

.
~ ~ " ~ F O ~ ,?:
oT~ ~ fW ; ~ ~ ~I : ~ p~ A ;i >f:P :h>>x+r;
~$ $ ;~~ ' C ,:.
.;~ ~ . ...- ..\ . ... .,- . r ...,,. ..-,:.
~?., ' %,, . :. . . .., .
A '

eCAPSlNEMIS ' 7- ~-.-


s kID:
Acrmn Requcst I Ibcce~vedby (Nameand Orgnnrzot~on):
hojvani Cock/ Event U: IbLact: I ~ a t e / ~ i r nSubmtted:
c 1u Chw)motmdwus~~

FElYIh Porm 90-136, MOV Oo


f

site WC: 1 s r , >~ ---FAX


#

State Approving Offiaal signature: Date: 3/9//>/


-
1x1. Sourcing the Requeat - rations Section Only)
Revkw by: 0 Donations 0Procurement
0 Log RevIew by: 0 Other (explah) 0 Interagency Agreement
0- ~oordlnatimby: Requid- MMon Assignment
C] Other Coordlnatlonby:
0 Other cowitnation tiy.
Immediate Action Required: U Yes C) No Action request EKY:
Date/Time Assigned: assigned to: othec

N: Statement of Work (Operations Section Only)


OFA Action Officer. 24 hour Phone: FAX#
FEMA Project Officer: 24 hour Phone: FAX#
JusM~cation/ Statement of Work:

Estimated Completion Date: I Cost Estimate:


-
L ~ 3 N - U
V. Action Taken (Operations Section Only)
C] Ampzed 0Rejeded 0 Accountable Property
Disposition: Coord~natcdwrth APO

--
eCAPS/NEMIS Task I D
Action Request # Received by (Nameand Organization):
Program Code/Event #: State: [ ~ a t etime
f Submitted 10 originated asverbdl
l " E U Form 90-136,BOV 04
D ~ ~ - ~ ~ ~ ~ - ~ ~ 31 3 - 0 0FL0 2 9 1
I.
K c c l u z s t ~ ~Naine/'Tille/State
i

Prl n ~ a n e n Phone
t

Requestor Organizat~on.

h b A/=
7
Fi3qh
11. Requested Assistance (Completed by Requestor)
ACTION REQUEST FORM
W h o is Requesting Assistance? (Completed by Requestor)
ESF*=2.

bl s,d G e / cqpc: 1.y c/ ~ g h w / M : q ; . r ~


Description of Ass~stanceRequested:

gc4e,
m-{
E-mail:
FnC b ?I ,?Ax
'rernpalary Phone/Fax t l -

FAX #.

-
-
OMB NO. 1660-0047
Expries yove-mber 30, 2007

&G
A see Attached

sofjj~t-
-
-

radio fepeqLekC'r KJ h d A;/ho/.le ~ e o , : k yf i kb/ i~ U&yr~ /--


CBQ
Quantity.
on/&----
Delivery-Site -a:<
- -- Priority:
u 3 High
ufesavlng
0 4 Medium
6 2 ~lfesustaining
05 Normal
Date/Time Needed.
O ? / O ~ / O ~ /mc/

State Approv~ngOfficial signature: Date:

111. Sourcing the Request - Review/Coordination (Operations Section Only)


Revew by:
CJ c7 0Donatbs Procurement
L .

Log Review by: / Other (explain) Interagency Agreement


Other CoordnaUon by: Requlsltlons Mlalon Assignment

Other Cmrdtnation by:


0 Other Cawdination by:

Immediate Action Required: Yes No Action request E5F #:


Date/Time Assigned: I assigned to: Other:

IV: Statement of Work (Operations Section Only)


OFA Action Offlcee 24 hour Phone: FAX#
FEMA Project Officer: 24 hour Phone: FAX#
Justification / Statement of Work: 1 4

Estimated Completion Date: ( Cost Estimate:


V. Action Taken (OperationsSection Only)
0Accepted C] R e w e d 10 Accountable Property
Disposition: Coordinated with APO

eCAPS/NEMIS Task ID:


Action Request # Received by (Name and Organization):
Program Code/ Event #:
;
State: I ~ a t e / ~ i mSubmitted:
e I Originated as verbal

FEMA Form 90-136,NOV 04


@UU3/UUl
03/08/?005 1 1 4 7 FAX

. .--"--- 370-
ACl"10lrJ REQ.UEST FORM ~ l l l HO,
l ~ 1660-0047
E r p i a a Nawmnber 30, 3007

--
Who is Requesting Assistance? ((Completed by Requestor)
,--
~AC- b ( l - 7'72,
t C . / A. D h Y ' -1 r>\- C ~ ~ ; & ~ ~Tcn~p~rary
- ~ o aPhonc/l:ax
) I

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Phone: FAX r:

et.8.w O w n i n d e * l .b
.% crp'7 . r> f j= 4 2 2 a:: p i IC-mnil:
,

Assistance (Complete& by Rcques t o r ) U 5a! N l a ~


ismnce Rcqucstcd: - "'.-

i.-{
p.i i 1 &I Ll
51,--.
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SmL Apprbving O I T M siprtelurcr

- Ft;vicw/~%ordination (wentioms Seotioa O n b )


111. Sourcing the Request
L - ~ P SRc+wW:&+
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W: Statement ofWoxk (Opurtiorm SgcCfaa OW)


lg V V J / u u I
U J , V O I ~ I I~ ~ 1~
9 rnn

I . 370
ACCTIOR REQUEST 3;"OR1\(I 0- lub. 16~1-0047
Lxpdss No'oocr~nMr30, 1007
. Who is Rcgucsting Assistance? (Completed by Requestor) Foe.
- b{(- T:~D
f -1 .C.

--- -
-
- - N'zh, 9n..L ~ Z K ~ J

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Approving O I T sicignaLurc:
~S~RLC ~ oxlc: J J ~ @j*
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111. Sourcing the Reqocst - ~&itw/(l%aard&tlon (*eratiens Section &ly)
1

o w - IIJ&--.\ CIOON#~ nvw-


u bg llrnnw m:
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Ilnte/T~sruAasigncd: osqgned to: Cl Mlm:

tv: Stmtenuat ef Work [Opurtionr Sarctioa W y )


OEA Actim C H f ~ c r z Phon~c:
34 IIUUF FAXW
FEMA Project OlXccr. 24 hoar F'home. PAX*
,luslificabon / Stalcmcnt crl W o r k

-
E:t im~tcd(:urnpletnin f1:ttc: I Costt E~lrtnatc.
V- Actias Taken (Opcrrtlons Scctionn Onty)
0- 13-
L>ispor.iLlor%.
r
,f/5- " 9/$/(!
I ACTION REQUEST FORM o m NO.i6do-0047
Expries November 30,2007
I. Who is Requesting Assistance? (Completed by Requestor) +

Requestor Name / Title/ State. ~ ~ , @ / n / 3,~ n/,&,/~&?


~/v', Temporary Phone/Fax #
Permanent Phone FAX #.

Requestor ~r~anlzatlon- E-mall: -


11. Requested Assistance (completed by Requestor) see Anached
Description of Assstance Requested:
1324-=
f3coRT M R b t?~(CK/4 , k
l/adn , me,/ &f /??fl.~f3/7c-'c 74
PRom ' ~ ;rd hfimd /4ducif A/RP~EI-.
NtZc/ oRLL'A-NS ~ / k Vpr
-. Quan tlty:
-$kf / 2 - l y & 2 6 5
Dellvery kite Locatio?i?
Pnonty:
8 I ufesavlng
3 H~gh 4 Medlum
2 w e sustaining
5 ~krnal
--
Date/Tlme Needed:

-
3,qmfi /?du7F- A/RPuR~ -===a-f a

site pot: FZ&%WD~,


/.d'm#R 24 Hour Phone:
State Approving Official signature: Date:

111. Sourcing the Request - Review/Coordination (Operations Section Only) i


OPS Review by: 1
0ona at ions - ~rocurernent I
Log Review by: 0 Other (explain) Interagency Agreement
Other Coordination by: Requbltlons Mission Asslgnrnent
Other Coordination by:
0 Other Coordination by:

Immediate Action Required: U Y" No Action request ESF #:


Date/Time Assigned: 1 assigned to: Other.
1
N: Statement of Work (Operations Section Only)
OFA Action Officec 24 hour Phone: FAX#
FEMA Project Officer: 24 hour Phone: FAX#
I
/ Statement of Work:
~~ustification -
I

Estimated Completion Date: I Cost Estimate:


V. Action Taken (Operations Section Only)
Oj~ccepted 0Rejected lo Accountable Properly
I~isposition: 1 Coordinated with APO 1

J
Action Request # l~eceivedby (Name and Organization):
Program Code/ Event #: State: I ~ a t e / ~ i mSubmitted:
e ( Originated as ver!~al

FEMA Form 90-136.NOV 04


~~~-F~MA-0033-0002953 FL
1.

- , 7p
c.PFFIQN
c.+FFIQN
71- I !-,i.'. 1 REQUEST FORM-
i.;. FORM - QIYB NO. 1660.0047

1. Who i s Requesting Assistance?' ~(CI=ornpleted


by Wcgucstor)
P

s ~ t ~ppravutg
e OITW signarure ~utc: ,Y,,~P
/as-
- (qparations Section Only)
11- Sourcing the Request ~aviehrj~~o&'in~tion

cxm- c by: 0 w.m w g n m


awl UMoyI*IM( by:
OmCllsdnr(Snby:
-
Immnlhte Action Requit.ed: U yts fl 4ctian m ~ e s t ES 8:a
te/Timc Arcsiwcd; 1 =igned ta: 5 ahn:
L

Nz Statmaerrt of Work [Opmtioasr Scctioa Only)


m

OFA Action OMicw: 24 hour k n c : PhYn


t'EMA Pwjn't Ofhccr; 24 hoar Qhu~e-. FAX@
JudGmtk / Smtenwnt of Work:

J,

I
-
Date:
E s t ~ m r c dCornpletlo~~ CmstEstirnate:
A

Action Taken {OperationsSeatian Only)


Oancucd 10 *ccamW,e-
..","", & r u d 8 8 7 1 1 ,.,, q J V l 1,UIL

d .

ACTION WQ'BIIIEST FORM OM8 Nu. XGGO-0047


Exprics Nouctrrlrr 30, 2007
1. ' Who is Requesting Assistance? (CComgleted by Elequcstor) d -5
. -
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-
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11. Requested Assistance (cornpktcrd by ~ e ~ k s t s a ) [:I !A": ur;wM

I c
i pliorl
J)c:;,..t

5 ' :, ,
af Asxi.;t:.r~rt,:r I<t.ilucstcd:

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~I
-
V. Action Taken (Operations Sectiaon Only)
4 E!rr~cd - [c) P1or..:,\v
_1ncrcallu~l~
*
ArCTION Rl3QUJEST FORM ciNU Ns 1060 004 7
X x p r ~ a aN v ~ . c n t t c ~30,
r 2607

Pcrmant:nr Pbor~c

..-
II. Rcquasted Assistance ( LJ !+c A~GIL??-~~

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rh, / r g +r Lxc c. sr L- ,",=,, , ,< ,.,) 6. ,#. l-,,.
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&-I c' C; /LC ,,.I .L (I?I ,~el
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-.
SUPOC:A//~,,;~,,, 21 Haur %ow I- FAX # - i7.

ppcnvin~Officid ilgnaturr Q&I~& /LAP-


. /' --.. l,,c-yfii~
I. Sourcing thc Request - ~eview/~%ordination [operat&ns ~&ctctlozSOnly) 4
F5 R Q U[*v:~-*
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3srii~;ncdm: ij (m.
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-
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N; Statement of Wark l ~ ~ e r a t i oBcrrctfon


ns Only)
1 4 hou: Phoxi: FLY P
24 hour Plwm: FA:<*

. ~

1
&stibznatcd Cnm~ldionfiate: C:(I::L~ Esr;m.ttrc:
V. Action Taken IOpentions Section (Only)
3 R.:CCJWO
-
t.J fr!p.~:rti<
-
39/08/2005 17 39 ' A X @uua/u~z

- Cxpricfl N o w m k r 30.2007
I. Who is Requesting Assistance? (4Complctcd by !Requestor) EPI/_ - A K- 379

--
E-tni~il:

n.
-4
Requested Assistance [Cothpleteed by Requestan)
I)cscription of Asstsr;tnc:c Rccjr!paccd:
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. .
Re ,,,, / r;,, .,LA,
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4

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A c. , 24 Hour i>t)mni:; .. . =FAY .---- - 41 li

Scale dypwvin~0Uici:i: siRrmutr,:: -


-
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0 ohm c:.wdlwlotl oy:


c1 o t r ~ c w h c i o n b v :
Immediotc Action Kequic-ed: UY m a NO A ~ ~ i o r n x @ q u r ~ i LSB:a
hte/Timc AssixnM: 46Ggncd to: 0 OUw:

iV: Statement o f Work (Operntwns Section Only)


1

-
Estirnnrrd Campleuoar Ilatc:
V. Action Taken (Operations Sectiam Only)
( Co:nt E ~ l ~ t t l i ~ l e .

CJ ncvnnrauc p ~ r w t t y

.
AC~JUFIf i C q ~ e s t# It ~ ~ c r u chyc l ( S a m311d0rgonlz;ltinn):
Proglum C'otlzl Eurnt U- 11~utc: Il)tctc/~irncStjbmictcd:

-A Farm 90-136.ROV 04
T -
. J ,---,-
L - r ;,i
*

I ACTION REQUEST FORM OMB NO. 1660-004 7


Expries November 30, 2007
I
I. W h o is Requesting Assistance? (Completed by Requestor)
IZt7c~uestnr
Name/T~lle/State

Permanent Phone: -\
- ,-L
I'
L - c : + x b - s , f ~ s Temporary Phonc/Fax #

FAX #:
I
-
11. Requested Assistance (Completed by ~ e ~ u e s t o r ) See Attached

Descriptiorl of Assistance Requested:

-
.-.
- -
- Priority-
I3 3 High
0 1 Ufesav~ng 4 Medium S Nor&-
Date/,T~meNeeded:
-I?!-; - -
_-
A

Delivery Site Locat~on: 7


---ae---

SltePOC*

l ~ t a t Approving
e
4-c:i~ ( 7 L . k t , L . . v c , .

Official signature:
24 Hour Phone:
- -
FX
-
Date:
1 '-
111. Sourcing the Request
w~
0
Review b y : h

Log Review by:


J- L-77-,u\,5 aoonatlons
13Other (explain)
-
- Review/Coordination (Operations Section Only)
0Procurement
flInteragency Agreement
Other Coordination by: 0 Requisitions Mlssion ASslgmIent
Other Coordination by:

I Other Coordination by:

Immediate Action Required:


Da le/Tjme Asslgned
U Yes a NO

I
Action rcquest
asslgned to: 0
ESF #:
Other:

IV: Statement of Work (OperationsSection Only)


OFA Actlon Oif~cer 24 hour Phone: FAX#
FEMA Project Officer: 24 hour Phone. - FAX#
J~istlfication/ Statement of Work

,
Estrmated Complet~onDate: Cost Estimate:
V. Action Taken (OperationsSection Only)
0Accepted 0.ejectb 0 Accountable Property
Disposition: Coordinated w t h APO

Action Request # Received by (Name and Organization):

>
Program Code/Event #: State: /~ate/~im
Submitted:
e 10 Originated as verbal

DHS-FEMA-0033-0003039 F
VS WESTER19 REGION

-
ECAPSINMIS task 0. ndmReqWatN0. P~ognmcaw€veni #:
O am-=-
hivedby (New ond +Wan); Stale: ~ ~ f r l!wmlaWk
t a
09/08/2005 1 8 ~ 2 4FAX 225 925 7501 LHLSEP @ I
001
I W*:kP:***********I$****
I
:r*o TX REPORT ,+-x.:c
*t**$*0***:R**X1:*0****

TRANSMISSION OK

TX/RX NO
RECIPIENT ADDRESS
DESTINATION ID
ST. TIME
TIME USE
PAGES SENT

-
RESULT
-

ACTION REOUEST FOG w --


-.
on&&. 1660-0047
Exprfes November 30,2007
. I
I. Who is Requesting Assistance? (Completed by Requestor) -
- .---
I

Request01 Narne/Title/Stale: xcTL


G(9L~Mrr~ Temporary Phone/Fax #:
Permanent Phone FAX #: --

Requestor 01ganizntion: L/L?># .. @p& 5 JGG,,jAirv ae&/,oa E-mail.


11. Requested Assistance (Completed by ~ e ~ u e s k o r ) A A,. See Auackd a
Description of Ass~stanceRequested:
~ c r l h / , C a i,455 t s - i l ~ c c

Quantity: Priority: a 1 ufaavms


€4 3 High
Delivery S ~ t eLocat~on.

Site POC: I;'";LbvLt& 24 Hour Phone

State Approving Official signature:


. Date:

111. Squrcing the Request - Review/Coordination (Operations Section Only)


lF-::;::;p--
r

Other Coordbmtlon by:


Donations

Other (explain)

(II~equisitions
IJ Procurement
Interagency Agreement

0 MissionAssignment
--
a Olller Coordlnatiin by:
Other Coordination by:

Immediate Action Required:


Date/Time Assigned:
U Yes No Action request
( assigned to:
0 ESF #:
Other:
I
IV: Statement of Work (Operations Section Only)
OFA Action Oflicer.: 24 hour Phone: FAX#
FEMA Project Officer: 24 hour Phone: FAX#
Just~fication/ Statement of Work:
DHS FEMA REGION S I X PAGE 02/02

--
- ACTION REQUEST FOFZM ~ 1660.0047
O M NO,
Fcrprics Naurmbcr 30.2007
I. Who is: Requesting Assistance? (Completed by Requestor)
-/g * *Fj"
. -

ix-~ . K - ~ ~ ~ / &
r<t:tluustor~ r ~ u n tit>*=: E-rnc~il:
11. Requested ~ssisthoce(Cornpletod by Requestor) - L l set ALTMUICU
Ucacriptic)l't of Rc:ycrc:;tcd;
As?bi>~trlncc

I'

-.

Mccliun~
-. .
Dc1ivc:t-y Siic Loub~Uln~:y - 1 . -
.-T u ' ~ w U
E-> ?
<*(> j .T-. ( ~ L(<-I- J
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- -----
14 1inur I'htmr:: FAX I/
...-
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0ll'i~i:il si,&nrrr\lt'C:
Slnls Aplx~>vir~g l)/t$ bate:
1x1. Soprcing the Rcquest - ~c&sw/Coordination(Operations Section Only)
0Dut~atluns 0 t'roctrrcmcnt
t:l.Orhwn (wldn) . fucrwmcv haroomam
L ~ ~ CQ
O ~ ~M
U ~ UIU W:
~
OII Q Rcrqvbliions Cj ~ f ~ l ow")nn~cnt
n
iJtberC~rdinnl;clrllY$! ,J
C] ~ t r w ~r w & , r q t l o n
by: J
Irnrnzelicllc Acri<,tl Rcquirctl: 1~ Y F - ; Nd Action rcqucsi i.2 eiP a:
Assi~,~~t:d:
Vr!Lo/'Ti~~lc
c
q i ( 0~a itxrigt~adto: Othnr:

XV: Shtamcnt ofWork (~~elratkons


Section Only)
UIiA ~ c ~ i oOMccr:
tl Y$ lrorrr Pt~ono: FA.X:,
' F ~ M Al'rojcc~Omcrr: 24 hour I'hanc: I P A X I/
.lustifirutiur~/ St.ntcmc:nl. or W o r k .-, 0

5- .-5 &:'ij;:- .[2


in. /1$Lj~a,t$t: - 2 )JK/60s kt, & ~ ( L { C B

Grtir~ratrdC'&mplct~onI > t d k : COgr Esnrnulc!:


V. Action Taken (Opentions Section Only) -
KJAccentrul U~ f l f c b c ~ U hCEDuntablC Prop~',Tt
Diuptr-lltlon: vf11A P O
~;.rc~nlln:~lrel

/ c ~ ~ I ~ s / NTask
% MID:
~s 4
Requestor Organ-tion: A 0 #, JhCu-+ ~ ~ / & ~ i / fE-mail:
11. Requested Assistance (Co eted by Requestor) 0 See ~ttached
Descnption of Assistance Requested: RtpkteGkr v e2 eeK 9, g/duA P k m$;
-kLqkt- J C. 24 ~ ' - b . c Ff zed
F ~ C ,

stirnated Completion Date: 1 Cost Estimate:


. Action Taken (Operations Section Only)
1 lg-fi51ected 0 Acmvntabk ffoperty
~sposrtion: Coordmated mth APO

a-e..0- . .
. , -,
* ! ; .

APS/NEMIS Task ID:


tioo Request # f ~ e c e i v e dby (Name and Organization):
,gam Codel Event 3-
1- ~ ~ ~ - ~ ~ ~ ~ - 0 0 3 3 - 0 0 0 3f 0 5 9
.-
t

T I . .

Permanent Phone:

Requestor Organuauon:
-
I. Who is Requesting Assistance? (Completed by Requestor)

I; /e f / 4

11. Requested Assistance (codh~leted

Quantity: '-
-
3-t . m t l L-J“~~Y$
-
-
?
LA
by Requestor)

p..i-&p
/
/ 1: ,)!

+
ACTION REQUEST FORM

iAq
~C(I
,+r4 /iA r,sL2 Temporary Phone/ Fax #%'

Nr ,, /f 4

s e r ~ . - ' , e.
a
FAX #.

E-mall:

~cltesusta~
OMB NO. 1660-004 7
Expries November 30, 2007
hK-YD3

DateITime Needed:
see ~ttached
-
-

a
6--f

see A-&L~( 4 Medium 0


S-NmI- 0 *
- k/' 5
a,
Delivery Site ~ o c a t i o n . x ~ , , 1 fg ,
,,- ---aie --
, I

3kQ/ ~ d ; d c s , ~ - .-.-
ecI n u / / G b l z L A ~ f i l<l
~ ~ POC:
t e &, s f-e 0 4 e f l 3 24 Hour Phone 4
c
- FAX # n

State Approving Ofici; signature: ~ T J - - $D a t e q / e

:::::-=J-+k-T-
I

IIII. Sourcing the Request - Review/Coordination ( ~ ~ e r a t < o&%tion


ns Only) I
&Muons Procurement

UOther (&ah) 0Intecagencl ~greement


Other Coordination by: (7ReqolStions Mlsslon AsQnment
Other CoordinaUon by:
Other CowdlnatJon by:

Immediate Action Required: U Yes 0 No Action request ESF IT:


DateITime Assigned: I assigned to: [7 Mher:
I
N: Statement of Work (Operations Section Only)
OFA Action 0ff:cer: 24 hour Phone: FAX#
~FEMAProject Officer. 24 hour Phone: A FAX#
I
pstification / Statement of Work
I

Action Request # Received by (Name and Organization):


Program Code/ Event #: State: I ~ a t e / ~ i mSubmitted:
e 1 0 Originatedas verbal
ACTION REQUEST FORM

Descnptlon of Assistance Requested:


4,,7,9 c p c c x + - 6-5 6'+d
Re"1, r p r / b + i e O/r
-
e " * \ p / b y e e $ , ,-a/-
- s1 f r LO* I C -
trn c.--)r
"'Y '99e.F.
- ~+~-;/erCo.-srG-.m.s~/,y,c,~.,5i
c-; / -5'cc.-1 cgj

~ l ~ f q , ' t , y LA 7 0 8 ~ 6
24 Hour Phone n.
State Approving Official signature: D a t e 9 N c

1111. Sourcing the Request - ~ e v i e w~yordination


f ( ~ ~ e r a t i / o ~gction
ns Only)
fcl-
0Donattons 0PrOcurernent
0 ~ o Review
g by: ) 00 t h (explain) D Interagency Agreement
Other Coordmatbn trq: Requldtions 0M~sslonAsignrnent
Other Coordlnabm by:
0 Othercoordinabmby:
Immediate Action Required: U Yes No Action request 0 WB:
Date/Tirne Assigned 1 assigned to: 0 OUEC

IV: Statement of Work (Operations Section Only)


OFA Action Officer: 24 hour Phone: FAX#
-
FEMA Project Officer: 24 hour Phone: FAX#
Justification / Statement of Work: B

Estlrnated Completion Date: Cost Est~mate:


V. Action Taken (OperationsSectign Only)
0Accepted a Relxted Acrwntable Property
Dlspos~tion: Cwrdmattd wth APO
\

- -- -

Lction Request # I~ecelvedby (Name and Organizadon):


I -
ACTION REQUEST FORM o m NO. 1660-0047 1
I . Expries November 30,2007
A 1
I. Who i s Requesting Assistance? (Completed by Requestor) FBGDK #t#D g a
~ M O E J O *1 &I& 695 Temporary Phone- I
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Requestor Organization: E-mail:
11. ~ e q u e s t e dAssistance (Completed by Requestor) 0 see Attached
Description of Assistance Requested: )(
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Quantity: % -- - Priority: 0i hfesavtng 2 bfe ssustalntng - DatefTime Needed:N
2q i 4 P . x / C A Y 3 nish C] 4 Med~urn .-TjTEoTmat
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smat -d 41 105
site P O C ~ FQEDR ~ ~ M O N O 24 Hour Phone: 2.28-3q3 -074 8 FAX #

aInteragency Agreement
a Mission Assignment

Other Cocrdlna#n by.


0
I Other Ca)rdinaUon by:

Immediate Action Required:


Date/Time Assigned:
*
U Yes 0 No
1
Action request
assigned to: C] Other:
aF #: 1
Ilk Statement of Work (Operations Section Only)
OFA Action Off~cer: 24 hour Phone: - FAX#
FEMA Project Off~cer. 24 hour Phone: FAX#
Justification / Statement of Work:
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^&r T R . w ~ / : P ~ X ~ ~ fedexa/ ~r5hk 6 F C ; ~ ; ~ l s
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Action Request I:
D ------ ,-->- ,-
l~eceivedby (Name and Organization):
I
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1
I
9

ACTION REQUEST FORM OMB NO. 1660-0047


Erpries November 30,2007
I. Who is Requesting Assistance? (Completed by Requestor)
-. 2 . .
y 12

Requestor OrganizaUon: E-mail:


11. Requested Assktance (Completed by Requestor) 0 seemed

Description of Assistance Requested: G ~ ~ ~ C , \4&b)h4


T T f a \ a bThEf=

-
-
-. - - --
Quantity.
--
Priority: a I umlog a 2 ~e urstantng DateJTlrneNeeded:
a 3 High 4 Medium 0s=%-
Delivesy Site Location: CL & ELi L\B N --
5002 ' M w r
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site POC: 3 1 1 ~ ~ 5 24 Hour Phonc FAX i

State Approving Official signature: Date:

111. Sourcing the ~e~uest/k&ew/~~oordination(Operations Section Only)


OPS Revtew by: --z& 0~~ Procurement

log ~ e v i e wby: gother (@in) 0 interagemyAgreement


7 other~oadtnationby: o
~es
ur
swo
ns 0 MissionAsdgment
3 Other Ccardlnatbn by:
7 Oehercmrdinathby:

rnmediate Action Required: U Yes 0 No Action request ESFI:


3ate]Tie Assigned: assigned to: othec

[V:Statement of Work (Operations Section Only)


>FA A c t i o n Oflicer: 24 hour Phone: FAX#
7EMA Project Officer. 24 hour Phone: - FAX#
lustification / Statement of Work-

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.
,A,,,,,
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ktimated Completion Date: I Cost Estimate:
r. Action Taken (Operations Section Only)

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:tian Request # Received by (Name and Organization):
ogram CodeIEvent #: state: f~ate/~im Submitted:
e 1
0originatedasvew
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~ ~ ~ - ~ ~ ~ ~ - 0 0 3 3 - 0 0 0F 3 0 8 3
2. Quantity 3.Priority: 0 Ufesam Lae sustaining Normal
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.- 5. DeJvefy Site 6. Site Point of Contact (POC) B


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8. Fax N

9. State Approving Official Swtuce


E
,4
- 4n Date

-
111. Sourcir)g the Request ReviewlCoardlnatlo~

A S . / 1

3.Immediate Action Required: 0 Yes NO , 4. Date


17. Assigned to
6. Action Request ESF# Other I

IV. STATEMENT OF WORK (Opera


1. OFA Action Officer: 2.24 Hour Phl
L
4. FEMA Project Officer: 5.24 Hour Ph
. . -
L/dbfi hk?&l/ 9ili-rqf - 5 yv
~ I -
7. Justification I Statement of Work

TRACKING INFORMATION (FEMA USE ONLY)


ECAPS/NEMIS Task ID: Action Request No. Program CodelEvent #:
0 Originated as verbal
L A - 7 ~ -01
n
Received by (Name and Organization): State: DatelTime Submitted:

I I I I
L
FEMA Form 90-136. NOV 04 (This particular form h a s been updated for compatibility with DART)
Y

Exp~resNovember 30.2007

I.Description of
Ww m K MAhlag~
FOR ATE, d o d - M O r r ~
2. Quantity 3. Priority: Lifesaving a Ufesustalnlng 0 Normal 4 te d Time Needed
7 (7 High a Medim $15 I T ~ S
5
5. Delivery Site Location: 6. Site Point of Contact (POC)
ILL BCY~~E
7.24 Hour Ehone NB.- 8. Fax No
-
9. State Approving O f f i e i g n a t u r e 10. Date
--
-- Ill. Sourcinp the -qR
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OPS Review by:


2.
a matrons

~og~evlewby: - Dother (-lain)


Requlsitions
Other Coordlnabon by:
prdcurement
Other Coordination by: Interagency A g m e n t
0 Olher Coordlnabon by:

3. Immediate Action Required: 0 Yes NO 4. Date


K Mkslon Assignment

5. Time Assigned

1 1
FEMA Form 90-136, NOV04 (This particular form has been updated for compatibility with DART)
. i

OMB NO.1660-0047

111. Requcstcd Assistance (Completed by Requestor)

Du rc/l'imc ~\s::i#ncd: I to:


:~:r:iijy~cd n O:IK.I:

nr: Statement of Work (Operations Scction Only)


OWA Acticln CIMccr: SD4 c , 24 hour I ' h o n c : F.4S :;
1:I:;Mn Prc.!iccr (..)I'ficcr: B ; I ,@ 24 hour lahonc: ):AX'#
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V. Action Takcn (Opcrations Section Only)
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FEMA Turrn 90-136.NOV 04


dCl'ION REQUEST FORM OMB NO. 1860-0047
Expries Nowmber 30.2007
I. Who is Requesting Assistance? -(Completedby Requestor)
Requestor Name/Title/State: Temporary Phone/Fax #. 0
Permanent Phone: FAX #:
Requestor Organizabon: dh5 A J / B Pm d ~-mail:&;e .
11. Requested Assistance (Completed by Requestor) /see Attached
Descript~onof Assistance Requested:

Quantity: Priority: 2 Life suna~n~ng Datel'Tlme Needed:


Dd 4 0 ; d m 4 Med~urn 5 Nmal 9/ c / D ~
Deli'& F : * & r
--
A~!&,~J~ d d d omh c //s4
+ ~ ~ ~ ' ; ~ l ~e 7~ & ~'6- "i
.2?

- -
24 Hour Phon- FAXI
7-- --
State Approving Official signature:
-==l@
-- Date:

-
III. Sourcing the Request ~epiew/~oordination(OperationsSection okJrj--
d OPS Rev~ewby: " -
o ona at ions Procurement
Log Rev~ewby: v •Other (explain) InteragencyAgreement
Other Coord~nabonby: ~Requlstbon~ MlSlM kslgnment
Other Coordlnabon by: ,
[7 Other Coordnabon by:
Immediate Action Achon request ESF B:
Date/?Yme Assigned: assigned to: Other:

IW Statement of Work (Operations Section Only)


OFA Action Officer: 24 hour Phone: FAX#
FEMA Project Officer: 24 hour Phone: FAX#

estimated ~o&letion Date: I Cost Estunate:


V. Action Taken (Operations Section Only)
Accepted Rejected Acmuntable Property
Coordinated wlth APO

t
~ g I N L i ' ~ Q m T I O N ; c p E ~ " .;;~ - N
~; ;.4<T-kj.j.j..+F-'
L ~ +A;$ If:f::<-L-t " , * .*
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eCAPS/NEMIS Task ID:
AcUon Request # Received by (Nameand Organization):
Program Code/Event #: State: I ~ a t e m r n Submitted:
e 1 O o n g ~ ~ t easdwrbal
FEMA Fonn 90-136.NOV 04
A1
'7 r*bTION REQUEST FORM OBlB No. 16600047
Expries Noumnber 30.2007
I. Who is Requesting Assistance? ((;ompleted by Requestor)
Requestor Name/Title/State: *&d;i~#/& Temporary Phone/Fax I: m
Permanent Phone:

Quantity:
O d &l'dQ
-L~LOCG 0 3 H~gh 4 Medium

b-fi+
0 2 Ufe sustamfng
5 Normal

m,9
IDatemrne Needed:
~/&JJ
~ 1 A
~ e

l ~ t a t Approving
e Official signature: / - ---- Date: I
XII. Sourcing the Request - Revjeq/Coordination (Operations Section 011ly)
d 0% Rev~ewby: J Donations Rmrement
~og~evtewby: ,/ other (explatn) 13Interagency Agreement
Other Coordination by: Requisitjons Mission Assignment
Other Coordination by:
Other Coordination by:
/
Immediate Action Required: wyes No Action request fl €SF #:
Date/nme Assigned: 1 assigned to: Other:

IV: Statement of Work (Operations Section Only)


OFA Action Officer: A I F / 24 hour Phone: FAX#
FEMA Project officer ( " & ~ f f&,& 24 hour Phone: FAX#
Justification / Statement of Work:

Estimated Completion Date: I Cost Estimate:

Coordinated wtth APO

eCAPS/NEMIS Task ID:


Action Request # . Received by (Name and Organization]:
Program Code/Event #: State: 1
~ate/TirneSubmitted: 1 Originated as verbal

FEMA Form 90-136,


NOV 04
Robert Fenton lOSC I
4. Requestor's Organization FEMA RIX- 5. Fax No. -
6. Email Address robert.fenton@dhs.gov

Other (explain)

Other toordlnatlon by:


Procurement
0 Other Cowdinatbn by: Interagency Agreement
Midon Assignment
I

3. Immediate Action Required: 0 Yes NO 4. Date 5. Time Assigned

6. Adion Reauest ESF# dr


other 1
7. Assigned to
N.STATEMENT OF WORK (Operations Section Only)
1. OFA Action Officer: 2.24 Hour Phone No. 3. Fax No.
I I
4. FEMA Project Officer: 5.24 Hour Phone No. 6. Fax No.
I I 1
'7. Justification / Statement of Work:

I
8. Estimated Completih Date: / 19. Cost Estimate:
\ / I
---(?I_ Action Taken (Operations Section Only)
Accepted 0 Acmuntable Pmperty Coordinated wlth APO

c
TRACKING INFORMATION (FEMA USE ONLY)
ECAPS/NEMIS Task ID: IAction Request No. IProgram CodeIEvent A t
I If IU Origjnated as verbal
I
ieceived by (Name and Organization): State: Datenime Submitted:

'EMA Form 90-136, NOV 04 (Thisparticular form has been updated for compatibility wiih DART)
w ""0, "V"
UJ/UYILVVJ uo . Y U rnn

v d el2 +&O. at-


/
,'7,--i>
,m a i s Requesdng Asdstanct? (Completed by Requestor} ,

Tcmporq Phone/Fax I-? -


Ouantihr! larioritv: 61 r ixesa~ncr 0 2 We sustaldng f~att/%e Needed:

I
DJivuy Site tocation:
Ford PsrR W t c t , 5115 1-10 Eaa4 &it 846, Ekaumont, TX

~sckaarcdCornplotion Date:
V. .Action Talcen (Operations Section ody)
I I
&st Estimate: f ~ ~ O j ~
okvtd QfWeUed
0 Aec0UneBblePmpwhr
Xepoaition:
d m
~ i l l o r r agth

-: .". tRqucarAl Rccdved by (Name a d Orgeni~~tion):


06 C o d e / E w #: Stetcr I~ate/TfmeSubmitted: I Q OMnaw as*
FEMA Action REquest Born
, . - ---
.-
- .

I . ACTION. -VEST M)RM ( 1 n t e G draft ns'of 610:


..
11. Who is ReauestiPn Assistance? lChmrrleted bv Repuestorl .. .

uestor Name/Title/State: Kent


- Weathers/SDLO/TX
- -- Temporary Phone/Fax #:

anent Phone: FAX #.


-
Requestor OrganuaUon: Region VI E-md: d
b
-
II. Requested k.ktanc8 (Completedby Requestor) see~ttsched
~ ~ e s c r i ~ tof
i oAssistance
n Requested:

I Move remaining JFO Kits from LC-Moffett to LC-FW

Quantity: Priority: • 1wmng 2 ufe wstain~ng Date/Tune Needed:


All 3 4 h 4~edlurn 0 slbr,"al ASAP 91 10/20(1
Delivery Site Location:
-
-- --&=-
. , -SEMA Logrstics Center. 510 W Felur Ave.. Ste. 1205. Ft. Worth,TX 761 1.5-3410

--
Site POC: hck H d a t - 24 Hour Phone:
-- - -
State Approving Officlal signature:
-- Date:
-
-
III. Sowcing the Request Review/Coordination (OperationsSection Only)
Cj O P S R ~ V I ~ W ~ Y : 10 ~onaborts Pmarement

~p

&Coordi~tlon by: 0 RequisitlMIS ~is-sica


Assignment
Other CoordiMtionby:
Omer Cowdination by:

mrnediate Action Required: U Yes 0 No Action request Ear:


D a t e / W c Assigned: / assigned to: Olher:

W.Statement of Work (OperationsSection Only)


OFA Action Officer: 24 hour Phone: FAX#
~ F E M AR-oiect Oficer: 24 hour Phone: FAX#
Justification / Statement of Work:

To stage remaining JFO kits closer to theatre.


Support relief effort for Hurricane Katrina

Estimated Completion Date: ( Cost Estimate:


V. Action Taken (Operations Section Only)
o~ccept
e d 0~e)ected 117 Accountable Prupedy
Disposition: Cwrd~natedwith APO

INEMIS Task ID:


Received by (Name and Orgamzatlon):
State: I ~ a t e f h r n Submitted:
e 1 onglnated as v e h

Katrina: arf49.xls
' ** ,* ~ -*- --- - ~ ..,-. <
-.*-,.. --
ACTION REQUEST FORM
- (Interim draft as of 6/02)

Requesting Assistance? fCompleted by Requestor)


Arkansas - Kent !\'eathers Temporar?, PhonejFax *
I
FAX @

Request or Organiz:cl!ion: FEMA-K6-KKCC-L,OG E-mail: .....

IX. Requested Assistance (Completed by Requestor)


Ilescription of Assistancr Requested:
SO prSrson JFO Kit for Arkansas .If"(>

ARF AR-AIi;F-001 is hereby cancelled and replaced by this ARF


- I~ a r e / T l m rheeded
Quantttv l~rlonrv
- 7

J 1~~'esdv~n~
- -,2 b f e sustantng
-

I I r--
2 rach ,_i, 3 H~gh 3 Medium S Norma 9/9/2005
- - -5
l)~'likr17,SILL'LlJCdilOll
-- ---r-
-,-
! 100i i.:xrtur,ve Center [)nvc, Ltrrle Rock, AK 7LLi ;
,~t.O-&~Gks;is
-

- --
S ~ t ePOC Kevln Cobb 24 Hour Phung

State Approving Official slgnatun. Not Kequlred

[2 Other Cuordrnaboli by.


[I Other Coordtnabon by: - .----
Other Caord~nat~on
by.
r--
1lmrnediat.e hclion Keclulred: .i Yes 9 &to

OFA Action Officer

~ F E M A~ r o i e c officer:
t
- 24 hour Phont:
24 hour Phone:
FAXI:
FA>(#
I1
/.iustificat,an / Statcrncnt of Work:
Set u p Arkansas JFO.

C:osr Esamate
*-_^--^- ~ - - - ~ ' . . . - >, - . .
.-I
I I ~ ~

- - --- ,"we--.-"--"-

$ . Accepted Re:ectec: AcrOd~ltab'fPV3p?Ty


!I > ~ \ p ~ \ t l ~ o r t Loordln.ilcd u~ih9t'O
i
!

--me-----

&i&CgBaQ fFEMA USE; O&LYj -b.w---z.e-~-~'--.--- -.


N E M I S Task ID:
F
f ~ c t i o R(:qurst
n #
--
h l (N;imr: iuiri (-)t-gan~zarionl:
.-.-. - --- .- -4
----- .- --.- -
f I'rogran~ Ctrde/l.:ven\ G :
-- --
I);~rv/'l'lrnr: Submii~.<-(!:
.--
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"-
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- -I-"--." I . ..,. --,.-
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---
1-*
-
r" *--a- .*- A
.-
-
+
... w --.x- -
ACTION REQUEST FORM (Interim draft as of 6 / 0 2 )
----
Who is Requesting Assistance? (Completed by Requestor)

0 person Admin Kit for .&rk:insas J i70

Quantity
2 earh
--

-
horit) -
z!
, I Lifesaving
3 Htgb
-
L 4 M&~urn
-
3 2 bfe suaarn~ng
i,5 Kormal
Dare/Ttmc Net-ded.
9/9/2005
13c.llocn Sltc. L?catlonrIG-
,1t~l~-~ax1sar7sas
11001 Eseccltivts Ccnrcr Drive, l.rr11r Hock, AK 72.21 . --
- -