Environmental Health Complaint Type of Complaint* Food Establishment Lodging Sewage and Solid Waste Water Air (Mold, Pollution, etc.) Name of Complaintant (Sewage complaints MUST provide a name. Others can be anonymous, if desired.)* First Last Address of Complaintant Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone Number of Complaintant*For followup, please provide us the best number to reach you at.Alternate Phone Number of ComplaintantEmail Address Website Description of Complaint*Please describe your complaint. Include address, directions, possibly hazards, available names, and thorough details and description of the complaint. The more information you provide, the better we can address it.PhoneThis field is for validation purposes and should be left unchanged. Δ