1. | You are not obligated to assist and you may withdraw your assistance at any time. |
2. | You cannot profit from assisting. |
3. | You must agree to act under the direction of the incident command agency. |
4. | You are not covered by this law if you caused the initial accident. |
| I have read and understand the above. |
| (Name) . . . . |
| Date . . . . . . Time . . . . |
| I am a representative of a designated hazardous materials incident command agency and I am authorized to make this request for assistance. |
| (Name) . . . . |
| (Agency) . . . . |
| Date . . . . . . Time . . . . |