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Full Name
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Organization Name
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Check if a Media Organization
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*Phone
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Ext.
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Ext.
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*Email
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State
Zip Code
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The Open Records law limits disclosure of certain records when the requesting person is incarcerated or committed to a mental
health facility. Details
The requestor identified above is
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If you have an Open Record Request that involves Environmental & Regulatory Service Division issues within the Bureau of Storage Tank Regulation or the Bureau of Petroleum Environmental Clean-up Fund Administration associated with Comm 10 regulated aboveground or underground storage tanks (e.g. petroleum tanks or petroleum contamination), select this option before proceeding.
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*Description of Open Records Requested
Describe the records requested. The request must be reasonably specific as to subject matter and length of time
involved. Continuing requests are not permitted. More information on records not subject to disclosure.
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Maximum of 2000 characters
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The above request pertains to records maintained (check all that apply)
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The request is related to (check all that apply)
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*I am requesting the records be provided
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*Fee Authorization
I authorize the Department of Safety and Professional Services to collect and provide copies of the records described above, to the extent that they are subject to disclosure, so long as the fees associated with the request do not exceed: $ Fee schedule
When the estimated cost of collecting and producing the records exceeds this amount, the Department of Safety and Professional Services will notify the requestor prior to incurring any collection costs.
*Required
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