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U.S. Department of Homeland Security
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Louis Llghtner, NDMS EC, RRCC Temporary Phone/Fax #:
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rhe DMATs at the New Orleans International Airport k$ the Mrcllcal Command Unit have requested a reefer truck for morgue u s e
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Rcqucsx a Disastcr Mcdicd Assistance Teem ( D m ? to assist 116th medical support at thc Dallas Reunion Arcna.
100 Colostemy Bags; 300 folding chairs; Air port benches to seat another 300 people, 20 wheelchairs; 15 - -
stretchers with wheels; 10 cases alcohol wipes, 5 cases baby wipes or similar product; 500 pair rubber
moties with traction bottoms, 3000 Triage Tags
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4703)805-9982 or 9983 or 3384 or 9985 or 9DOt&or 9987 or 9988 ur 9989
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1The D I A will execute aerial imagery acquisitions to support the wnnnuing search and rescue, (weemonitoring; hydraulic piping;
chemlcal/ollIsewage spills and leaks; emergency engineering and shoretino erosion missions.
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Disposition:
FEMA Form 90-136, NOV 04 (This particular form has been updated for cornpatibiliiy with DART)
U.S. Department of Homeland Securrty Lm 54979'
See Reverse for
OM0 No 1660-0047
Federal Emergency Management Agency Expires November 30.2007
Paperwork Disclosure
ACTION REQUEST Notice
I. REQUESTING ASSISTANCE (To be completed by Requestor)
6. Email Address
-
b - I
11. Requested Assistance (Completed'by Requestor) I
I.Description of Requested Assistance:
Ill. Sou-he -
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Disposition: ,
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I FEMA I
Form 90-136, NOV 04 (This particular form has been updated for compatibility with DART)
1
I U.S. Department of Homeland Security OM8 No.1660-0047
h i 4 H~uc
Phone Nq. - 18. Fax No.
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1. OFA Action Officer. 2.24 Hour Phone No. 3. Fax No.
6. Fax No.
FEMA Form 90-136. NOV 04 (This particular form has been updated for compatibility with DART)
U S Department of Homeland Security Lo6 Tk"d%' OMB No. 1660-0047
See Reverse for
Federal Emergency Management Agency Exp~resNovember 30.2007
Paperwork Disclosure
ACTION REQUEST Notice
1. REQUESTING ASSISTANCE (To be completed by Requestor)
1 Re uest~r's
Nam ease Print) 2. Titfe
&e1&1 5. Fax No. 6. Email Address
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4. Date
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IV. STATEMENT OF WORK (Operations Section Only)
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D
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FEMA Form 90-136, NOV 04 (This particular form has been updated for compatibility with DART)
U.S. Department of Homeland Security II LSee G #foiJ ~1
OReverse OM8 No. 1660-0047
Federal Emergency Management Agency n ..,. -. . Expires November 30, 2007
raperworn ulsclosure
ACTION REQUEST Notice
I. REQUESTING ASSISTANCE (To be completed b y Requestor)
se Print) 2. Title
2 . Quantity 3. Priority: a Ufesaving Life sustaining Normal 4. Date and Time Needed
High Medium
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2APSlNEMIS Task ID: (Action Request No. (Program CodelEvent #:
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xeived by (Name and Organization): State: DatelTime Submitted:
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:MA Form 90-136,NOV 04 (This particular form has been updated for cornpatihility with DART)
In. Requested Assistance (completed by Requestor) a nrrx)r~rl
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ACTION REOUEST FORM om IVO. 1660-0047
E.uprics Novcrnber 30. 2007
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ACTION REQUEST FORM OMS No. 1660-0047
&prlcs Novemhr 30.2007
I. W h o i s Requesting Assistance? (Conipletcd by Requestor)
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11. Requested Assistance (Completed by Requestor) SCCAR~CIC~J
kscription of Assistilncc: R q n ~ s t c d :
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ACTION REQUEST
- FORM OMB NO. 1660-004 7
Evprlas Nowmbfr 30.2007
I. Who i s Requesting Assistance? ]Completed by Requestor)
1~crrnirnencPhorre: FAX a :
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Exprles Nowmbcr 30,2007
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14. Date 15. Time Assigned
3. Immediate Action Required: @yes NO
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IV. STATEMENT OF WORK (Operatl
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Permanent Phone:
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Requestor Organization:
- Action Request Foorm
I. Who is Requesting Assistance? (Completed by Requestor)
Requestor NameITitle / State: Kent WeathersISDLO /TX
Region VI RRCC
11. R e q u e s t e d Assistance (Completed by Requestor)
Description of Assistance Requested:
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Temoorarv PhoneIFax #.
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F E U Form 30-136.NOV 09
ACTION REQUEST
- FORM OBQ NO. 1660-0047
W r l c 6 Nowmbor 30.200:
I. WGo is Requesting Assistance? (Completed by Rcquestor)
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PRAC%INO XNFOBMATION (FEMA USE ONLY):.-.=' :. i..: . .. . .. . .. . .. . I. .
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d o n Rprqucsc u *ecetved by (Name and Orgnnizntion):
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LOG#350
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F ~ M AForm 90-136,NOV 04
I. Who is Requesting Assistance? ICompleted by Requestor)
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Requestor Narne/Title/State'
Permanent Phone/ Fax it:
Requestor
Orgamznt~on
0 State U EMAC ROC EST
Temporary Phone/Fax #:
U See Anached
Forklift--rough terram 5 or 6 K for use at Dmorgue site. per~odof performance 9/03/2005 thru 9/30/2005
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NEMIS Task ID: Estimated completion date: Cost estimate: Accountable Property
Coordinated with APO
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ACTION REQUEST FOFZM o m NO. 11560-0047
Exprtcs Nnriernlcr 30, 2007
I. Who is Requesting Assistance? (Completed by Requestor)
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See Reverse for
Federal Emergency Management Agency Expires November 30.2007
Paperwork Disclosure
ACTION REQUEST Notice
I. REQUESTING ASSISTANCE (To be completed b y Requestor)
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I ACTION REQUEST
- FORM o m NO. 1660-0047
YCprla:; NaocmLar 30.2007
I. W h o is Requesting Assistance? (Complctcd by Requestor)
Rcquesro~Name/T~tlc/Stocr phi1 - 1 3 t-
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8 5 ; Ei3/2005 2 3 : 02 5124247160 PAGE 62iB7
. . . 388 -T
1 ACTION REQUEST FORM (Interim draft as of 1/03)
I. Who is Requesting ~s'sistance?(Completed by Requestor)
Niune/mlJcJSttxte:
I~e~ucstor Jack Collcy/SCO/TX Tcrnporq Plaonc/Fax #:
1
LCrmm,~ a FAX ft: mi
Requestor 0rgmice.tion: TXDEM E-mnil: '
11. Requested Assistance (Completed by Requestor) [I see Attached
Dcscription of Assistance Requested'
Request a Diaestcr Medical f~8sistanccTeam (DMAT) to assist with medical support in Dallas. The team should constst ol20
doctors, 30 nurses and 30 pharmacy tcch's. Plus 35 portable ahowcrs.
-
Estimated Completion Date: 1 Cost Estirnatc:
-- - - - ---
-- - ---
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V.--ActionTaken (Operations Section Only) --
0 Accepted 0 Rejnted ACCDUntabte Propcny
Disposition: Coordinotcd with &PO
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111. Reauested Assistancc lC0m~letedbv Reauestor\
cj ~ : hCoco~.<lirmlicn
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IV: Statement .ofWork (Operations Section Only)
0 F A Action Cjrfiwr: 24 liaur Phone: AX R
FEMA Project Officer: 24 hour Plwnc: FAXP
Ju:;lificnTim / Starcrlmnr ol' Work:
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I. REQUESTING ~sslStmce/Toba compfstcdby Requator)
COC cldl LA
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II. Requested Asslstancc (Fornpicted by Requestor) I
7. betxripliorr of Requested A661otanoe:
I
2 CDC staff rnemben,are nRsd9d for EPI amd infection control enofis. The CDC people wlll bc laca ad ar tho LA Office at Public EOC in
Beroo Rouge. Wlll need staff kf about two woaks. Will need lo CinU Hausing for the CDC mff.
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3. Inmird$le Acllon Rsqnimd: a Yes NO 4. D m 5. Timm Asigned
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111. Sourcing the ~equest,&~eview/~oordination(Operations Section Only)
24 Hour Pbone: .
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