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REQUEST TO ACCESS A GOVERNMENT RECORD <br />This is a model form that may be used by a Requester to provide sufficient information for an agency to process a <br />record request. Although the Requester is not required to use this form or to provide any personal information, <br />the agency needs enough information to contact the Requester with questions about this request or to provide its <br />response. This request may not be processed if the agency has insufficient information or is unable to contact the <br />Requester. <br />DATE: 08-25-2021 <br />TO: Hawaii County Department of Environmental Management <br />Agency that Maintains the Government Record <br />cohdem@hawaiicounty.gov <br />Agency's Contact Information <br />FROM: request+b8x23aakwx@foi.uipa.org <br />Requester's Name or Alias <br />request+b8x23aakwx@foi.uipa.org <br />Requester's Contact Information <br />AS THE REQUESTER, I WOULD LIKE THE FOLLOWING GOVERNMENT RECORD: <br />Describe the government record as specifically as possible so that it can be located. Try to provide a record name, <br />subject matter, date, location, purpose, or names of persons to whom the record refers, or other information that <br />could help the agency identify the record. A complete and accurate description of the requested government <br />record will prevent delays in locating the record. Attach additional pages if needed. <br />The contract, invoices and payments to the County contactors for the July 2021 engineering build -design <br />and report for the Pahala Wastewater Treatment Plant sent to EPA on July 23, 2021. <br />I WOULD LIKE: (Please check one or more of the options below, as applicable) <br />❑ To inspect the government record <br />❑ A copy of the government record: (Please check only one of the options below.) See the next page for <br />information about fees and costs that you may be required to pay for agency services to process your <br />record request. Note: Copying and transmission charges may also apply to certain options. <br />❑ Pick up at agency (date and time): <br />❑ Mail (address): <br />[X] E-mail (address): request+b8x23aakwx@foi.uipa.org <br />❑ Fax (toll free and only if available; provide fax number): _ <br />❑ Other, if available (please specify): <br />❑ If the agency maintains the records in a form other than paper, please advise in which <br />format you would prefer to have the record. <br />oIP 1 (rev. 12/1/2015) <br />