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* 1. Who is the Point of Contact for firefighting foam management?

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* 2. Does your agency wish to participate in the Department of Ecology’s voluntary PFAS containing firefighting foam disposal program?

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* 3. Do you manage/store Class B foam that qualifies for the state’s disposal program? Qualifying Foam includes any foam:

1) manufactured before 2003; or
2) where the date of manufacture is unknown; or
3) with any of the following acronyms: AFFF, AR-AFFF, FFFP, AF-FFFP, FP, FPAR on its label; or
4) that is unlabeled; or
5) mixed with other foams

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* 4. If you answered yes to question 3, what type of foam does your facility have? Select all that apply.

Our department has foam that:

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* 5. If you answered yes to question 3, at what type of facility is the qualifying foam stored? Select all that apply.

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* 6. What type of container is the foam stored in? Select all that apply.

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* 7. How much qualifying foam do you estimate is being stored on site?

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* 8. What percentage of your entire firefighting foam stockpile does the qualifying foam represent?

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* 9. What is the condition of the foam’s container/s? Select all that apply.

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* 10. Is there any qualifying foam stored within an apparatus or other firefighting equipment?

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* 11. Where did the qualifying foam come from? Select all that apply.

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* 12. Do you know of any other PFAS containing foam stockpiles that are not managed by fire agencies? If so, who is the point of contact?

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* 13. Any other information on the state’s foam disposal program you’d like to share?

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