FOIA Request Form

FOIA Request Form

To:

From:

Date:

Document(s) Requested

This will request that your agency provide me copies of the following materials:

MSDS submitted pursuant to Section 311 of Title III, 42 U.S.C. 11021.

List of MSDS chemicals for which a MSDS is required as described in Section 311(a)(2) of Title III, 42 U.S.C. 11021(a)(2)

Emergency response plan prepared and submitted pursuant to Section 303 of Title III, 42 U.S.C. 11003

Hazardous chemical inventory forms (Tier I) prepared and submitted pursuant to Section 312 of Title III, 42 U.S.C. 11022.

Hazardous chemical inventory forms (Tier II) prepared and submitted pursuant to Section 312 of Title III, 42 U.S.C. 11022. (Please specify companies.)

Follow up emergency notice provided in accordance with Section 304 of Title III, 42 U.S.C. 11004(c).

Toxic chemical release forms submitted pursuant to Section 313 of Title III, 42 U.S.C. 11023.

List of facilities required to report and submit data pursuant to Title III, 42 U.S.C. 11001 et seq.

Other (please describe with specificity)

I make this request pursuant to one or more of the following acts, regulations, or both (check all that apply):

Federal Freedom of Information Act

State Freedom of Information Act

Federal Emergency Planning & Community Right-to-Know Act

State Emergency Planning & Community Right-to-Know Act

This agency's implementing regulations

These documents are believed to be publicly available and they are probably within the custody of your agency's office.

Payment of Costs

(please check only one box)

I understand that I may be required to pay for the cost of searching, reviewing, and copying and am willing to pay up to $__________. If for some reason the cost of processing my request exceeds this amount please notify me at the following phone number before proceeding any further:

I certify that I am exempt from having to pay for the cost of searching, reviewing, and copying and hereby request that a fee waiver be granted. I make such a request on the basis that one of the following applies to me:

The request does not further a commercial trade or profit interest and is therefore not subject to review and document processing costs.

I make this request as a representative of an educational institution for a purpose that includes scholarly research. My institution and purpose qualify this request for waiver of all the applicable fees.

I request that the document release be expedited. In the event that the request for waiver is being considered for denial, I request telephone notification to the following telephone number so that I may provide further information to qualify this request:

Under your agency's fee waiver policy, if a final decision not to waive is made I request a written statement of the reasons so that I may appeal the denial.

Sincerely,