AQMD Logo

Complaint Intake Form

Calendar
May 23, 2013
June 18, 2013

You may use the form below to submit your air quality complaint. The AQMD will initiate an investigation within 24 hours of receipt of the complaint. Please provide your name, address, phone number and email if you wish to receive feedback during and upon completion of an investigation. We might contact you for additional information. The response time may vary depending upon the nature of the investigation.
You may contact the AQMD at (916) 874-4800 or (800) 880-9025 to verify that your complaint is received.

AQMD Complaint Intake Form
  Fields marked with the * are required.
  First Name
  Last Name
  Address
  City
  State    Zip    -
  Home Telephone ( ) - ext.
  Work Telephone ( ) - ext.
  E-mail  
  Source of Problem *
  (Name of company if
  applicable)
  Location of Source *
  (Address if possible)  

  Complaint
  Description *

Comments






spacer file