General Information

Are you an:
Individual
Public Official
Anonymous

What is your name?
What is your street address?
What town or city do you live in?
What county do you live in? Adams Allen Bartholomew Benton Blackford Boone Brown Carroll Cass Clark Clay Clinton Crawford Daviess Dearborn Decatur Dekalb Deleware Dubois Elkhart Fayette Floyd Fountain Franklin Fulton Gibson Grant Greene Hamilton Hancock Harrison Hendricks Henry Howard Huntington Jackson Jasper Jay Jefferson Jennings Johnson Knox Kosciusko LaGrange Lake LaPorte Lawrence Madison Marion Marshall Martin Miami Monroe Montgomery Morgan Newton Noble Ohio Orange Owen Parke Perry Pike Porter Posey Pulaski Putnam Randolph Ripley Rush St. Joseph Scott Shelby Spencer Starke Steuben Sullivan Switzerland Tippecanoe Tipton Union Vanderburgh Vermillion Vigo Wabash Warren Warrick Washington Wayne Wells White Whitley
What state do you live in?: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Distric of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
What is your ZIP code?

What is your daytime telephone number?
What is your evening telephone number?:
What is your e-mail address?

Tell Us About Your Complaint

Is your complaint about:
Pollution
The Agency

What is the name of the person and/or business you think is responsible (i.e., who is causing the pollution or is the reason for your complaint)?

Name of person and/or business:
What is the street address for where the complaint is occurring?
What is the city for where the complaint is occurring?
What is the county for where the complaint is occurring? Adams Allen Bartholomew Benton Blackford Boone Brown Carroll Cass Clark Clay Clinton Crawford Daviess Dearborn Decatur Dekalb Deleware Dubois Elkhart Fayette Floyd Fountain Franklin Fulton Gibson Grant Greene Hamilton Hancock Harrison Hendricks Henry Howard Huntington Jackson Jasper Jay Jefferson Jennings Johnson Knox Kosciusko LaGrange Lake LaPorte Lawrence Madison Marion Marshall Martin Miami Monroe Montgomery Morgan Newton Noble Ohio Orange Owen Parke Perry Pike Porter Posey Pulaski Putnam Randolph Ripley Rush St. Joseph Scott Shelby Spencer Starke Steuben Sullivan Switzerland Tippecanoe Tipton Union Vanderburgh Vermillion Vigo Wabash Warren Warrick Washington Wayne Wells White Whitley
What is the state for where the complaint is occurring? Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Distric of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
What is the ZIP code for where the complaint is occurring?
What is the telephone number for where the complaint is occurring?

Please provide driving directions to the location of the complaint

Where does this activity specifically occur e.g., in the back of the green building; on the southwest corner of the property; in the parts washing room?

Have you talked with anybody else about your complaint?
Yes
No

If you answered yes, please tell IDEM who you talked to, when you talked to them, and what was discussed

What is your complaint about and how are you affected by it?

When did it occur i.e., the date(s) and time(s)?

How are you aware of it e.g., I currently work there, I live nearby?

Is there anything else you want to tell IDEM?