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Request for Public Records

2. Requestor Information

4. Name

5. Date

7. Company

9. Mailing Address

11. City

12. State/Zip

14. Phone Number

15. Fax Number

17. Email Address

19. Preferred Method of Contact In the Event of Questions

21. Requested Records

    Requests must be for records in the possession of, prepared, owned, used, or retained by Ross Valley Sanitary District. Requests should reasonably describe identifiable records. The intake staff is available to assist you in identifying the records in the control of the District based on your description.

23. Time Period Covering Documents Requested
    Time Period Covering Documents Requested Start Date

    —

    Time Period Covering Documents Requested End Date

25. 1. I wish to inspect the requested documents

    I wish to inspect the requested documents, where applicable, and do not want copies produced at this time. I understand the District must be given time to locate and review documents responsive to this request in order to comply with the provisions of the Public Records Act. I will, therefore, be requested to make an appointment to return at a later date to view the documents.

27. 1. I would like copies of the requested records

    I would like copies of the requested records and I understand that I will be required to make payment for the copying costs for this request. The charge for copies is $ 0.25 per 8.5 x 11 inch page, and $0.40 per 8.5 x 14 inch page, or the “direct cost of duplication” if the volume of documents requested necessitates the use of a professional copy service.

29. Signature of Requestor

31. District Office: 2960 Kerner Boulevard, San Rafael, CA 94901

33. District Office Hours : Monday through Friday, 7:30 a.m. to 4:00 p.m.

35. Timing of Response:
    The District will provide you with a response no later than 10 calendar days from receipt of the request, to notify you whether records will be disclosed, unless a Notice of Extension for Response is sent. The ten-day response period starts with the first calendar day after the date of receipt. If a request is received after business hours or on a weekend or holiday, the next business day will be considered the date of receipt. If the tenth day falls on a weekend or holiday, the next business day will be considered the deadline for responding.

    The District will provide you with a response no later than 10 calendar days from receipt of the request, to notify you whether records will be disclosed, unless a Notice of Extension for Response is sent. The ten-day response period starts with the first calendar day after the date of receipt. If a request is received after business hours or on a weekend or holiday, the next business day will be considered the date of receipt. If the tenth day falls on a weekend or holiday, the next business day will be considered the deadline for responding.

39. 1. Inspection Requested:

41. Appointment for Inspection Date and Time

    (Must be during District's regular office hours)

43. 1. Copies Provided

45. Mail Service Requested

    1. Yes
    2. No

47. Electronic Format Requested

    1. Yes
    2. No

49. Estimated Cost of Duplication

50. Estimated Cost of Mailing (if requested)

52. Date of Payment Received
    Date of Payment Received

53. Amount of Payment Received

55. Date Request Completed
    Date Request Completed

57. District Staff Who Approves Completion

Leave This Blank:


59. 1. Receive an email copy of this form.
60. Email address

    This field is not part of the form submission.

61. Submit

* indicates a required field