Environmental Enforcement Referral

2. Submitter Information
4. Submitted By
5. Agency
7. Office Number
8. Mobile Number
10. Email Address
12. Violation Description
14. Location of Offense
15. Nature of Violation & Timeline
17. Complaints Against This Location
19. Property Owner (If Known)
21. Name
22. Phone Number
24. If the referral is submitted by a regulatory agency:
26. Date of Last Inspection
    Date of Last Inspection
28. Findings of Last Inspection
30. Any Other Information
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32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit

* indicates a required field