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COMPLAINT FORM WILLIAMS COUNTY COMBINED HEALTH DEPARTMENT
COMPLAINT NO:__________________ DATE:______________ NATURE OF COMPLAINT: SOLID WASTE SEWAGE HOUSING AIR LEAD WATER NAME OF INDIVIDUAL COMPLAINT REFERS TO:________________________ LOCATION OF COMPLAINT:____________________________________________ COMPLAINTANT:_________________________ PHONE #___________________ SANITARIAN INVESTIGATING:____________________ DETAILS:_________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ |
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