Los Angeles City Fire Department Telephone (213) 978-3691 Email: lafdrfi@lacity.org 200 N. Main St., 17th Fl., Los Angeles, CA 90012
Request for Information Hazardous Materials Records
*PLEASE COMPLETE THE REQUIRED TOP PORTION. INCOMPLETE FORMS WILL NOT BE ACCEPTED. (ALLOW 10 WORKING DAYS FOR PROCESSING)
Request Date: ________________ Requester’s Name:__________________________________ Email: _______________________________ Company/ Agency: __________________________________
PH.#: _______________________________
Address: __________________________________________________ Unit/Ste.: _____________________ City: ___________________________________ State: _____________
Zip: ______________________
PLEASE NOTE: YOU MUST PROVIDE A FACILITY ID # FOR ACTIVE/INACTIVE RECORDS. VISIT http://www.lafd.org/public-records TO VIEW LIST OF ALL HAZARDOUS MATERIALS RECORDS. INFORMATION IS REQUESTED FOR:
Check all that apply:
Active HM Records
Inactive HM Records
Facility ID No: __________________________________________________________________________ (e.g.: FA0000000)
Site Address: ______________________________________________ Unit/Ste.:___________________ City: _______________________________________________________ Zip: ______________________ Reason for Request: _______________________________________________________________________
FOR OFFICE USE ONLY CREDIT/DEBIT CARD PAYMENT SERVICE FEE ADVISORY: EFFECTIVE JULY 1, 2020, CREDIT OR DEBIT CARD PAYMENTS ARE SUBJECT TO A NON-REFUNDABLE 2.70% SERVICE FEE WHICH WILL BE PROCESSED BY OUR THIRD PARTY PAYMENT PROCESSOR, EVALON INC. THIS RATE IS SUBJECT TO CHANGE BASED ON CREDIT/DEBIT INTERCHANGE RATE.
NO INFORMATION ON FILE HARD FILE DESTROYED INFORMATION AVAILABLE Facility I.D. No.: ___________________________ Request No.: ______________________________ Processed Date: ____________________________ APPT. TO REVIEW FILE: __________________ Processor Signature:_________________________
Fire Prevention Report Initial Fee* # of pgs. ________x $0.10 =
x $11.00 $_______
*Per Facility ID
TOTAL: $_____________________