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<br />LANE Rf .'~IONAL AIR POLLUTION AU-r.'~ORITY <br />COMPLAINT FORM <br /> <br />00\ <br /> <br />.,.,.. <br /> <br />Date Received: &-)0 -Cf7 Time Received: Q9~O <br />Compl ainant Name /BerG:-- S;;pri C:,j( <br /> <br />, <br /> <br />Complaint No: ~ L/ <j 07 6<S-oa <br />Phone h~ c-;y~~) <br />City ~~ <br /> <br />Address <br /> <br />location of Complaint Condition <br /> <br /> <br />Date and Time of Complaint <br /> <br />Frequency of Occurrence <br /> <br />Source: ~ S;~G- <br />Location ALt..:iLI'ttR..- 'of- {)/ ~ <br />Type of Complaint: <br />v/Fanout <br /> <br />E. I. t,t"o. <br /> <br />City <br /> <br />Visibility (Aesthetic) <br /> <br />_ General Air Quality <br /> <br />Fume <br /> <br />Visibility (f raffle Safety) <br /> <br />General Practice <br />(Field jSlash) <br /> <br />Odor <br /> <br />Smoke (Impact) <br /> <br />Expense <br /> <br />Health <br /> <br />Smoke (Visible) <br /> <br />Other <br /> <br />Type of Source: <br />~ndustry <br /> <br />Fugitive Dust <br /> <br />General <br /> <br />_Open Burning <br /> <br />Field Burn <br /> <br />Stash Burn <br /> <br />Backyard Burn <br /> <br />_ Home Heating <br /> <br />Unknown <br /> <br />Other <br /> <br />Complaint Received By: <br />Referred By: <br /> <br />~- <br /> <br />Investigator: <br /> <br />TF <br /> <br />