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<br />LA N E REG ION A L AIR P OL L UTI 0 N AUT H 0 R IT Y <br /> <br />(o,3[S <br />Date Received Time Received \\)'.\)t)I\I~ complaint NO:~~~~ <br />Complainant Name "J.\J~ L:::t-~"DL '-I Phone 1 1.{l.{ :l1.oG <br />Addres~lt\ ~\) lJ0K~L 'f\R ! city S1~~6l'Lf-lJL) <br />Location of Complaint condition \[;,'\----'C"S: L~{"""/ \~\~~~~ ~tsSt1;,:'~A/1....~{'--~"<7..J'v.. <br />Date & Time of Complaint '~'\"(.,~~. .. . . . <br /> <br />COM P L A I N T <br /> <br />FOR M <br /> <br /> <br />Frequency of Occurrence <br />Source: '\)\)~~.S~\Q 't.. G~\j{:'L <br /> <br />Loca tion '\ ~ \.) ~~.1 N'\S- - <br /> <br />EI No. <br /> <br />city <br /> <br />Type of Compla'int: <br /> <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 Industry ~gi~ive Oust <br />o Field Burn 0 Slash Burning <br />o Unknown 0 Other <br />Complaint Received By: ~~ <br />Referred <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 General <br />o Backyard Burn <br /> <br />o Open Burning <br />o Home Heating <br /> <br />IIlvestigator: ~~ <br /> <br /> <br />