Form Section 1
Environmental Health Complaint Form
Type of Complaint
Location of Complaint
Name of Business or Owner (if known). Please be as specific as possible
Date/Time of Incident. Please be as specific as possible
Description of Complaint
If you would like a response, please leave your name and a phone number or email. If you leave this information, it will be part of the public record. If you would like your complaint to remain anonymous, do not leave a name or contact information.