Chris Data Request Form

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California Historical Resources Information System
CHRIS Data Request Form
ACCESS AND USE AGREEMENT NO.:________________ IC FILE NO.:______________________
To: ____________________________________________________________________ Information Center
Print Name: ____________________________________________________ Date: _____________________
Affiliation: _________________________________________________________________________________
Address: ________________________________________________________________________________
City: ________________________________________ State: ________________ Zip: __________________
Phone: __________________ Fax: __________________ Email: ____________________________________
:
Billing Address
____________________________________________________________
(if different than above)
Project Name / Reference: ___________________________________________________________________
Project Street Address: ______________________________________________________________________
County: __________________________________________________________________________________
Township/Range/UTMs: _____________________________________________________________________
USGS 7.5’ Quad(s): ________________________________________________________________________
PRIORITY RESPONSE (Additional Fee): yes
/ no
TOTAL FEE NOT TO EXCEED: $___________________________
Special Instructions:
Information Center Use Only
Date of CHRIS Data Provided for this Request: ___________________________________________________
Confidential Data Included in Response: yes
/ no
Notes: ___________________________________________________________________________________
_________________________________________________________________________________________
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