01252024-5Requestor 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 714-433-6022. 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 714-765-4040 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 6/30/_____.
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