Roseville PurpleAir Sensor Interest Form

Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email*

example@example.com

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

To the best of your knowledge, do you live within 500-1,000 yards of the Roseville Railyards (main neighborhoods: Los Cerritos, Roseville Heights, and Theiles Manor)*

YesNoUnsure

Will you occupy this residence or business for at least one year from filling out this form?*

YesNoUnsure

Is there a place outdoor that can accommodate an air sensor: has an outdoor outlet, WiFi access, and electricity?*

YesNoUnsure

Is there a place that the air sensor can be installed off the ground (for example, a fence post)?*

YesNoUnsure

Is there a place where the sensor can be installed that is away from other emission sources such as kitchen hood vent, grill, generator, chimney, or a firepit?*

YesNoUnsure