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2. Inspection Upon Request
   
4. If you need assistance, please contact us or visit one of our locations.
   Office Locations
6. Please Select your Inspection Type*

   See definition below for inspection types

   1. Plan Review

   1. Routine Inspection

   1. Training Inspection

   1. Export Letter
8. Please provide short description with reason for request:*
10. Plan Review
    Plan Review: inspections can be requested by the owner/operator of a permitted facility or a un- permitted facility. If a permitted facility is to be inspected the owner of the facility must agree to and fill out the rest of this form. After the fee has been processed, the assigned inspector will contact the owner within 5 business days to arrange for inspection. If requesting for more than one permit a separate application must be filled out with the fee. Inspection upon Request is not for facilities that have already submitted plans. Note: Please be advised that changes to the operation, physical facility or menu from the time of the Inspection Upon Request may result in additional items being corrected prior to final approval and issuance of the permit to operate.
12. Routine Inspection
    Routine Inspection: at the request of the owner/operator, will consist of one mandatory un-announced inspection. This inspection will occur 1-3 days after the application is processed. Inspection upon Request may only be approved once every 12 months for each permit. If requesting for more than one permit a separate application must be filled out with fee. Complaint Inspections and Foodborne Illness Inspections will be conducted as usual during this process and will not be counted as an Inspection upon Request. Inspection upon Request and the fees associated with this inspection in no way guarantee the operator of a specific award.
14. Training Inspection
    Training Inspections: can be requested and the subsequent follow up inspection will not be required and the establishment’s next scheduled inspection will be set according to the risk assigned to that permit. Training inspections can be requested more than once per year but will only be accepted as the time is available to do so.
16. Export Letter
    Nutritional Supplement wholesalers or similar establishments looking for an export approval letter from the department may request an inspection. Correction of Health Code violations may be required to obtain letter and one additional follow-up inspection, if needed, to determine compliance will be provided with this request.
18. Permit Number (If applicable)
19. Name of Establisment
21. Address
23. City
24. State
25. Zip Code
27. Name of contact person
28. Phone Number
30. Email Address
32. Payment Information
    Fee: $240.00 Once the Department has reviewed and accepted your submission our team will contact you via email with payment instructions.
34. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
36. Disclaimer
    Information entered on this form will be retained by Maricopa Environmental Services Department and is a record as defined by Arizona law. This form will be provided without redaction in response to a public record request unless any of the information is exempt from release under Arizona law.
38. Electronic Signature
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40. 1. Receive an email copy of this form.
41. Email address

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