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2. Complainant Contact Information
4. Anonymous Complainant

   1. Yes
   2. No

   If you prefer to remain anonymous. Check "Yes" and skip to the next section "Alleged Violator Information".

5. May city staff contact you for any follow-up on your complaint?

   1. Yes
   2. No
6. How would you prefer to be contacted?

   1. Email
   2. Phone
   3. USPS Mail
8. Complainant Name
9. Phone
10. Email
12. Street Address
13. Apt./Suite No.
15. City
16. State
17. Zip
21. Alleged Violator Information
23. Name of Alleged Violator, if known
25. Type*
    -- Select One --BusinessWaste HaulerLocal Government AgencySchool or College Medical Facility Other
27. Alleged Violator Address
28. Apt./Suite No.
30. City
31. State
32. Zip
36. Category of Alleged Violation*
    -- Select One --Illegal DumpingUnauthorized Use of Waste BinsPublic Health and Safety IssueViolation of CA Legislation (14 CCR Chapter 12)Other
38. Violation of California Waste, Recycling, and Recovery Law *

    Select all that are applicable

    1. Missing signage or labeling on waste bins
    2. Improper inspections of bins
    3. No edible food recovery program
    4. No waste, recycling, or organics collection service(s)
    5. Other
40. Date when was the alleged violation first noticed?*
    Date when was the alleged violation first noticed?
42. Description of the Alleged Violation*

    Please describe the alleged violation, provide as much detail as possible, including the location(s) of the violation.

44. Please upload any supporting images or documents
46. Any additional known witnesses of the alleged violation
48. Witness Name
49. Phone
50. Email
52. Witness Name
53. Phone
54. Email
56. Witness Name
57. Phone
58. Email
Leave This Blank:


59. 1. Receive an email copy of this form.
60. Email address

    This field is not part of the form submission.

61. Submit

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