Online Air Quality Violation Report Form
IMPORTANT:
If you choose to use this online form please include your name, address, a phone number and email address so we can verify your complaint. Without this essential information, we are unable to process your complaint.
Privacy Policy:
Your information will be kept confidential. Only complaints regarding locations in Maricopa County are investigated.
Name of Business or Establishment (if applicable)
Address (if known)
Major East/West Street or Road
Major North/South Street or Road
Corner of Intersection: NE   NW    SE   SW
City   *required
Description: *required
Date of Occurence:
   
Time of Occurence:
Your Information:
First Name *required
Last name *required
Address *required
City *required
State *required
Zip *required
E-mail Address *required
Phone: *required
Type
Area Code
( )
Number
home    work    mobile
Alternate Phone:
Type
Area Code
( )
Number
home    work    mobile
Would you like to be contacted in reference to the outcome of this complaint?
YES       NO