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Northeast District Citizen Concern Form

Please fill in the following with as much information as you have available. Any details you provide will allow us to better serve you and provide a swift resolution to the issue.

1. Location of concern (Please provide an address or intersection) *This question is required.

2. Please choose one or more applicable categories for your concern

Air Quality / Odor
Beaches and Coastal Areas
Docks
Drinking Water
Hazardous Waste
Oil/Chemical Spill
Solid Waste Sites
Storage Tanks
Storm Water
Surface Water
Waste Dumping/Burying
Wastewater
Wetlands/Protected Lands
Other - Write In (Required) Please enter an 'other' value for this selection. * This question is required.

3. In what location are there air quality and/or odor concerns?

3. What time and duration did you observe odors? (Example: On [Date] from 10 AM to 11 AM for 10 minutes)

3. How would you classify the intensity of the odors?

Faint

Extremely Strong

3. Description of concern *This question is required.

4. Please attach any related media or files (10 files maximum, 50 MB each)

File: {{filename}} delete

Please fill in the remainder of the questions with your personal details. Upon review of the completed form, Department staff may contact you with additional questions and follow-up.

If you wish to remain anonymous, please skip to the end and submit your concern. Please note, if you choose to enter your contact info, you will not be able to remain anonymous due to Florida public records law.

5. Name

6. Phone Number

7. Email Address This question requires a valid email address.

8. Preferred Method of Contact