b'Emergency Response CapabilitiesPipeline AssociationPublic Awareness Emergency ResponseCapabilities forThe Emergency Response Capabilities Database & Reporting Tool is a free, web-based resource developed to enhance emergency preparedness and emergency response planning in communities with pipeline infrastructure.It can be accessed at: http://capabilities.pipelineawareness.org Please provide your organizations response capabilities by filling out both pages of this form andemailing it topipeline.association@pipelineawareness.info. Your information will be entered into the database and included in the online reports. After your information has been entered, you will receive a confirmation e-mail with your assigned username and password. You can also enter your organizations capabilities directly in the online application at: http://capabilities.pipelineawareness.org.Organization InformationOrganization Name:_________________________________________________________ Contact Name:_____________________________________________________________Contact Email: _____________________________________________________________Contact Phone:____________________________________________________________ Organization TypeResponse AgencyPipeline OperatorLocation InformationLocation information allows capabilities to be reported by state and county. You can list up to three states with the corresponding counties below. Attach a separate listing if your jurisdiction includes more than three states.State:______________________________Counties:_____________________________ ____________________________________ ____________________________________State:______________________________Counties:_____________________________ ____________________________________ ____________________________________State:______________________________Counties:_____________________________ ____________________________________47 2020 by Pipeline Association for Public AwarenessPERG 2020 Final.indd 47 8/5/20 4:17 PM'