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Requestor Information: Date: Company Name: Address(es): Contact Name: Address: City, State, Zip: Phone: Fax: Email: Please check box to indicate the preferred method of contact in the event of questions Fire Incident Report Fire Incident # (if known) A Date of Incident: Approximate Time: Location of Incident (specific address or cross streets): If the incident involved a vehicle, the following information must be completed: Vehicle Make: Vehicle Model: Vehicle Year: Hazardous Materials Section / Certified Unified Program Agency (CUPA) Chemical Inventory CUPA Consolidated Permit On-site Treatment (TP) Information Inspection Reports Investigation Reports/Complaints Business Emergency Plan Risk Management Plan Correspondence/Referrals List of all USTs in Anaheim Hazardous Waste (HW) Generator Information List of all ASTs in Anaheim Underground Storage Tank (UST) CUPA Information Life Safety Section Inspection Worksheet Complaints 850 Forms Correction Notice/Second/Final Notice Fire Code Permits Correspondence 5-year Sprinkler Report Private Hydrant Test Report Other FEES: Photocopies Color Copies Laserfiche Records copied on CD $0.20 per page $0.45 per page $1.00 per page $10 per CD for the initial record series and $1.00 per additional records series Please note that HMS site maps are not provided and that chemical locations, financial information and personal phone numbers will be redacted/removed from all records. If items listed above are necessary for review, a certified release of information letter from the business must be presented with your request. Most HMS records are maintained in Laserfiche and have a five year retention length after they become obsolete. For UST records (prior to 1991) and HW and TP records (prior to 2001), contact Orange County Health Care Agency, Environmental Health at [PHONE REDACTED]. For UST Clean-up Information, contact the City of Anaheim Public Utilities Department at 714- 765-4238. To review Anaheim Fire & Rescue records in person, call [PHONE REDACTED] to make an appointment. I understand that I will be notified within ten (10) calendar days from receipt of this public records request. If production of records is requested, an estimated cost will be provided to me and I agree that I will be required to submit payment for duplication costs (and mailing) prior to the production of the requested documents. If arrangements for payment and production are not made within twenty (20) days of the date of the City’s response, I understand that a new request may have to be submitted. I wish to inspect City records (**not applicable for Fire Incident Reports) I will pick-up records Please mail records Signature of Requestor: For office use only: Record searches are retained for the current fiscal year, plus two prior fiscal years. Destruction date for documents contained in this request is Emailed DC Operations _ / / Emailed Request for Extension / / Date Report Ready / / Amount Due: $ Amount Received: $ Date Paid Method: Check# Credit Card # (last four digits only) Cash REQUEST FOR PUBLIC RECORDS CITY OF ANAHEIM ANAHEIM FIRE & RESCUE 201 S. ANAHEIM BLVD., SUITE 300 ANAHEIM, CA 92805 (714) 765-4040 (714) 765-4608