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KLICKITAT COUNTY EMERGENCY MANAGEMENT BUSINESS EMERGENCY CONTACT FORM Business Name: Telephone Physical and Mailing address of business: Owner(s) name: Contact number: What are your normal operating hours? Does your business have an alarm system? Yes____ Is it an audible: Yes____No___ What type: Burglary___Panic___ Smoke____Fire____ Other:_____ What is the Alarm Co. name: Telephone # Does your business have video surveillance? Yes____ No Any hazardous/combustible materials on site? Yes (List additional items/locations on back) Please provide a list of contact telephone numbers for contact person(s) in the event of an incident or alarm. List them in the order that you would like them contacted. NAME Telephone number(s) 1) 2) 3) 4) Signature: Date: _ Print Name Note: Please use the reverse side of this form for any miscellaneous information that you feel we did not cover or that you feel we need to know. The information contained on this form will not be made public. Please send to: 199 Industrial Way Goldendale, WA 98620 or email [EMAIL REDACTED] SIGN