Air Quality Complaint Form

Complainant Information

Name

Phone Number

Do you want a follow-up phone call or email?

Yes

Do you want your personal information to remain confidential?

Yes

Type of Problem

Asbestos

Burning

Dust

Industrial Emissions

Odors

Date of Most Recent Occurrence

Description of the Problem

Source of Problem (Individual Name or Company)

Source Phone Number

Directions to source of problem:

Complaint ID

You will be provided with a Complaint ID upon submission.