NORTH SHORE SANITARY DISTRICT

                                                    FOIA Request Form - E-Mail

                      Requestor:                                  

                      Company / Organization:             

                      Mailing Address:                         

           City / State /Zip:                           

                       Phone:                                       

                       Fax:                                           

                      Contact e-mail address:              

 Describe in detail below the public records you are requesting and state whether you wish to inspect and/or copy such records. Also, please state whether such public records are to be certified.

 Please provide the date range of your request:    

 Is your request for a "Commercial Purpose"?     Yes   No

"Commercial Purpose" is defined as the use of any part of a public record, or information derived from a public record, in a form for sale, resale, or solicitation or advertisement for sales or services.