California Public Records Request Act

Name of Individual and/or Company Requesting Records(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Telephone(Required)

Fax

Contact Person(Required)

First Last

Please complete one copy of this form for each public records act request. You will be advised as to whether or not we have records subject to release within 10 calendar days of receipt of the request. There will be a charge of 10 cents per page for any request made.

REQUEST FOR RECORDS PERTAINING TO:

Name: Facility Name, Location, Project, Individual, etc.(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

SPECIFY TYPES OF INFORMATION REQUESTED(Required)

CAPTCHA