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<br />LANE REGIONAL AIR POLLUTION AUTHORITY <br /> <br />C 0 H P L A I N T FOR M <br /> <br /> <br />Date Received~~~\\~ Time Received \\\~()\J ~J~ <br />Complainant Name (}'N\.S)~"f"!\"~\.)' <br /> <br />o ~f~ <br />complaint No: ~ <br /> <br />Phone <br /> <br />Address city <br />Location of Complaint conditio~~It ~~~ \b'\~-2.'(J~~ ~j\\{",-Vl"J 'h. \Ah(-~ \'-'B.~ <br />Date & Time of complaint \r'S.~~ . . . <br />Frequency of Occurrence <br /> <br />Source: ~~ S"~\D~ <;~"J-{:.t- <br />Location \"- V\)\S:.\0{-~ <br /> <br />EI No. <br /> <br />city <br /> <br />Type of Complaint: <br />o Fallout <br /> <br />o Visibility (Aesthetic) <br /> <br />o General Air Quality <br /> <br />o Fume <br />o Odor <br />o Health <br />o Other <br />Type of Source: <br />o Indust~y <br />o Fie1d Burn <br />o Unknown <br /> <br />o visibility (Traffic Safety) 0 General Practice <br />o Smoke (Impact) (Field/Slash) <br /> <br />o Smoke (Visibility) 0 Expense <br /> <br />o Fugit,ive Dust <br />o Slash Burning <br />o other <br /> <br />o General <br />o Backyard Burn <br /> <br />o Open Burning <br />o Home Heating <br /> <br />Complaint Received By: <br />Referred <br />Remarks: <br /> <br />Investigator: <br /> <br /> <br />.~LJ~~~) <br /> <br />- <br /> <br />~'" <br /> <br />Investigation Results: <br /> <br /> <br />~ 1(g-1 <br />