Outdoor Burn Notification Form

Outdoor Burn Notification Form
Please complete this form prior to conducting any controlled outdoor burn. This information helps Benton County Fire District #4 respond appropriately if a concerned citizen calls 911, reducing the chance of unnecessary dispatch to a controlled burn that has already been reported.

Important Requirement:
Before conducting any outdoor burn, you must contact the Benton Clean Air Agency and follow all current burn regulations. Visit bentoncleanair.org or call the burn line at 509-783-6198 to confirm burn status and requirements.
Contact Information
Name of Responsible Individual (on-site contact)*

First NameLast Name
Business Name (if applicable)
Cell Phone Number (on-site contact)*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Burn Details
Location of Burn (address or detailed description)*
Date and Planned Start Time of Burn*

MonthDayYear
Date
Hour MinutesAM/PM Option
Estimated Duration of Burn*
Acknowledgement
I confirm that I have contacted the Benton Clean Air Agency to verify that today is a burn day and will follow all applicable regulations. I will also monitor the fire at all times and conduct the burn safely in accordance with local requirements.
Signature*
Date*

MonthDayYear
Date
Submit this form prior to ignition.
Should be Empty:

Contact Information