Highland Paving Asphalt Plant Observations Form
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Your Name
*
First Name
Last Name
Your Email
*
example@example.com
Date of Observation
*
-
Year
-
Month
Day
4 digit year, 2 digit month, 2 digit day
Date
Time of Observation
*
Hour Minutes
AM
PM
AM/PM Option
If you detected a smell in the area, how strong was the smell?
1
2
3
4
5
1 star being lowest, 5 stars being highest
Add a description of the smell
e.g. rotten eggs, metal, etc.
Do you have any underlying health condition such as asthma or other respiratory illnesses that was triggered after you smelled it?
What was the air quality index (AQI) number reading at the time?
Enter number for closest monitor to your home
Upload any pictures you have taken. This includes, but not limited to, billowing smoke stack or increased traffic to the plant property.
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