Report an environmental health issue:
Fields mark with an asterict (
*
) are required.
About you
Name
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
E-mail
*
About the incident or request type
Type
*
--Please select one--
Report body crafting health concerns
Food safety concerns
Hotel or motel health concerns
Request a mosquito assessment
Request help with rodents (rats and mice)
Report a failing septic system
Request an septic system inspection or permit
Request a certification letter for a septic system
Swimming pool, spa or beach concerns
Request well water testing
Name of facility
Facility address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Facility Phone
-
Area Code
Phone Number
Describe the situation
*
If rental property, please provide as much as possible
Are you a tenant or the owner?
Tenant
Owner
Landlord name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone
-
Area Code
Phone Number
Additional details
SUBMIT
Should be Empty: