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01252024-2200 S. Anaheim Blvd., Suite 217 Anaheim, CA 92805 714) 765-5166 • fax (714) 765-4105 www.anaheim.net Request for Public Records Page 1 of2CityofAnaheim Office of the City Clerk STEP 1:COMPLETE all fields on this form. This form is to facilitate and expedite the processing of your public records request. Describe identifiable records in the possession of the City; your request must be sufficiently focused and specific to allow the City to locate the requested record(s). STEP 2:SUBMIT completed form by mail, fax, email or in person to Custodian of Records, Office of the City Clerk, 200 S. Anaheim Blvd., Suite217, Anaheim, CA 92805; tbass@anaheim.net fax: (714) 765-4105 STEP 3:WAIT to receive a response from the City. The City shall determine within 10-days from receipt of a public records request, whether the request, in whole or in part, seeks copies of discloseable public records in possession of the City GC 7927.535(a)]. Please note that if you are requesting the opportunity to inspect records, you will be requested to make an appointment to return at a later date/time to view the documents. Charges for the direct cost of duplication will apply . Documents will not be copied until payment has been received. If payment is not received within 20 days after invoice is sent, you may be required to submit a new request. Please see backside for additional information. REQUESTER INFORMATION Full Name:Date: Company Name: Mailing) Address: City/State/Zip Code: Phone number: Email: Preferred method of contact in the event of questions: Margaret Louise Hernandez 1/25/24 4:34 PM N/A West Covina CA 91790 91790 com626- call cell phone DESCRIPTION OF REQUESTED RECORD(S): (Describe the specific public record(s) e.g., date, type, time period covering documents requested etc) On 1-16-24 at 11 am I was at the East Anaheim Library with my 2 grandchildren & husband. While walking around with my grandson in the children's area, there was a small orange tunnel with mats on either side of the tunnel. As I was walking by the tunnel, my left foot caught the mat and I fell to the ground hitting my right shoulder, right knee and my right foot, As I was down on the floor, 2 women, unknown, came down on the floor to ask me if i was ok. I answered NO! A few minutes went by and I felt arms under my arms and someone was picking me up off the floor and placing me into a chair. After placing me into the chair, I turned back and this person was gone. Within a few minutes, less than 5, Rachel Tustin, Principal Librarian, East Anaheim, came to me asking if I needed her to call 911. I said NO! While Rachel was talking with me, she was telling a young man, who worked there, to pick up the big blocks that were scattered on the carpet ares in front of the children's computers. While Rachel was filling out the accident report, I requested a copy for my records. Rachel said that I could pick it up in a few days. A week later I called the East The information entered to request for public records is continued on succeeding page(s) I understand that I will be contacted once documents have been identified. If production of records is requested, an estimated cost will be provided to me and I agree that I will be required to submit payment for duplication costs (and mailing) prior to the production of the requested documents. Please note that information contained in any PRA request is a public record and may be subject to public inspection pursuant to the California Public Records Act. I wish to inspect City records X Will Pick-Up Records Electronically Signed/Submitted 1/25/24 4:34 PM SIGNATURE OF REQUESTER Please Mail 200 S. Anaheim Blvd., Suite 217 Anaheim, CA 92805 714) 765-5166 • fax (714) 765-4105 www.anaheim.net Request for Public Records Page 2 of2CityofAnaheim Office of the City Clerk DESCRIPTION OF REQUESTED RECORD(S)-Continuation Anaheim Branch to speak to Rachel and was told she was on medical leave. They told me to give Nissa Perez, Principal Librarian, Canyon Hill Branch and told me that I needed to fill out this form. Immediately afthe my fall at the library, my husband drove me to Kaiser Urgent Care, in Baldwin Park, where I spent 4 hours to be seen and treated for my injuries.kjjjjjj