Requests & Concerns Requests & Concerns "*" indicates required fields Type of Concern*Food/RestaurantBusinessOtherDate* MM slash DD slash YYYY Time* Hours : Minutes AM PM AM/PM Describe Concern*Location Name* Address* Street Address City File UploadMax. file size: 256 MB.If you would like to include any documentation, please upload that here.Your InformationName* First Last Email* Phone*Truth Consent* By checking this box; I certify that the information provided on this form and any accompanying document/images is true, complete, and correct to the best of my knowledge and belief.*Court Consent If deemed necessary you also agree to testify in court. (If this box is not checked, this complaint may not be able to be used for enforcement)
