NWAC Exercise Scheduling Form 
New ¨ Reschedule ¨

Sponsor Information
Sponsoring Company:
Agency:
Facility/Vessel/Barge/Pipeline:
Address:
City, State, Zip
Local Point of Contact:     E-Mail:
Telephone:     Fax:
Exercise Coordinator
Exercise Coordinator:
Agency/Company
(if other than Sponsoring Co.):
Address:
City, State, Zip
Telephone:                                                                                           Fax:
E-Mail:
Exercise Information
Type of Exercise:                                                   
Date and Time of Exercise:                                Approx Number of Participants:
Location of Exercise:
Exercise Scenario:

 
Components of Response Plan Exercised:
Objectives to be Met:
Responsible Party:
OSRO:
Other Participants:
Agency Presence Requested? Yes¨   No ¨ Agency:
Federal On Scene Coordinator ¨    State On Scene Coordinator ¨   PIO (JIC)¨
 Trustee Agency Env. Unit ¨    GRP Deployment ¨   Wildlife Rescue ¨

Please return to:
Elin Storey, Washington State Department of Ecology, Spill Preparedness Section, Northwest Regional Office, 3190 160th Ave S.E, Bellevue, WA 98006  Phone:(425) 649-7111, Fax: (425) 649-7098, email: eabr461@ecy.wa.gov