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2. Name
3. Email Address
5. Address
7. City
8. State
9. Zip Code
11. Phone Number
13. What is your complaint about?*
    -- Select One --AsbestosFugitive DustOdorOpen BurningParticulateSmokeOther (explain in summary)
14. Date & Time You Noticed the Problem*
    Date & Time You Noticed the Problem

    Date & Time You Noticed the Problem
16. Detailed Summary of Problem*
18. Name of Individual or Company Causing the Problem (if Known)
20. Address or Area Where the Problem Is Occurring*

    Be as specific as possible and give directions if necessary.

22. If you have photos, upload them here.
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24. 1. Receive an email copy of this form.
25. Email address

    This field is not part of the form submission.

26. Submit

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