File Review Request Form
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1CUPA
San Bernardino County Fire Department • Hazardous Materials Division
620 S. E St., San Bernardino, CA 92415-0153 • (909) 386-8468 FAX (909) 386-8460
FILE REVIEW REQUEST
I hereby request access to or copies of the following identified record at no charge other than the fee for any
copies (10 cents per page).
I hereby request access to the Hazardous Materials Emergency Business Plan only, pursuant to Chapter 6.95,
Health and Safety Code, community right-to-know provisions.
I am the owner of the facility or property described below.
FACILITY OR PROPERTY NAME
________________________________________
PROPERTY ADDRESS (exact address must be provided)
____________________________________________
____________________________________________
RECORD TYPE
_______________________________________________________________
RECORD DATE
___________________
FILE OR I.D. NO. __________________________
DOCUMENT DESCRIPTION _______________________________________________________
REQUESTED BY:
Individual Name
_________________________________
Title ________________________
Company Name
_________________________________________________________________
Mailing Address
_____________________________ ______________________
_________
Phone No.
(
) _________________________ Fax ( ) ___________________________
Email address:
_______________________________ @ ________________________________
SIGNATURE:
________________________________________________ DATE ____________
This is NOT a request for Certified Hazardous Materials Records Search Finding Report.
Records retrieved and provided are based solely on the information provided above.
A separate application is required for each record requested.
Access to or copies of any reasonably identified record not otherwise restricted by law or exempt from disclosure will be
provided without charge except direct costs of duplication upon a written request that includes the above information.
Copies of records will be made at a charge of 10 cents per page. A maximum of 40 pages can be selected for copying. In
the event more than 40 copies are required, bring a portable copier or digital camera to your appointment, or contact a private
copy service who can come on site, make copies, and arrange delivery to you. (We are unable to authorize removal of
original records from this office).
Hazardous Materials Division files are working files and may be signed out to various Division program staff. There may be
a delay in retrieving records if records are signed out to staff. Once the record is retrieved and evaluated, a file review
appointment can be scheduled. You will be contacted by phone to schedule an appointment or arrange copies.
Records provided for public review are screened and evaluated for information for which disclosure is not required or is
prohibited by law, or for which the interest in non-disclosure clearly outweighs the interest served by disclosure.
AGENCY USE
FR
Contacted ____________________________________
Reference ID
- _____________
Appt.
___/___/___ ___:___ am/pm
Date Rcvd
___/___/___
Rev. 2/13/14
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