Complaints Form

Complainant Type*

Confidential means that you will receive letters regarding the status of the complaint but your Name, Address, and Telephone Number will not be released to anyone outside this agency. Unrestricted means that all complainant information is available to the general public. Anonymous means that the complainant (you) did not wish to leave your information.

First Name*

Last Name*

Your Email Address*

Street*

City*

State*

Zip*

Your Phone Number*

Your Business Phone Number

Complaint Description

Address of Complaint Site or Directions

County of Complaint Site

Responsible Party's Name

Responsible Party's Street Address

Responsible Party's City

Responsible Party's State

Responsible Party's Zip

CAPTCHA

Email

This field is for validation purposes and should be left unchanged.

General Search

Document Search

Department of Environmental Quality Environmental Complaint Form