Complaints - Environmental Protection

Complaint/Investigation Request and Report Form

Date: (mm/dd/yy) Time: Number:

*If this is occurring after hours / weekends / holidays, please contact the emergency responder at (321) 689-8461 and leave a message.,

Complaint Description:

Previously reported to E.P.D.?

Complainant Information: Anonymous (Please Note: If anonymous, we will not be able to contact you if there is missing and/or incorrect information. You may call (407) 836-1468 Mon - Fri / 8 AM - 5 PM for follow-up.)
Name:
Address:
Zip Code:	Phone:

Violation Information:
Violator's Name:
Address (or General Location):
Zip Code:
Remarks:

Please enter the following numbers into the box provided.

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