Form 4400-277 (10/11) - Solid Waste or Hazardous Waste Complaint

Notice: Complete this form to voluntarily report a solid waste or hazardous waste complaint to the Department of Natural Resources for follow-up. Personal information collected will be used to investigate the incident and may be provided to requesters to the extent required by Wisconsin's Open Records Law [ss. 19.31-19.39, Wis. Stats.].

The DNR's Violation Hotline provides Wisconsin citizens with the opportunity to confidentially report suspected wildlife, recreational and environmental violations using a toll free number. The hotline number is in operation 24 hours a day, 7 days a week. Trained staff relay reported information to our conservation wardens. Anyone who calls the hotline or provides information can remain anonymous. Call 1-800-847-9367, 24 hours a day.

Instructions: Please provide the information requested below. You are not required to fill in section A, but contact information almost always makes investigation of a complaint easier. Without the contact information for the person making the complaint and the phone number for the person being complained about, we may not be able to adequately follow-up.

A. Contact Information Of Person Making Complaint

First Name:

Last Name:

Address:

City:

State:

Zip:

Telephone:

Email:

B. Who is the complaint against?

Business or Individual Name:

County:

Telephone:

Email:

Address:

City:

State:

Zip:

C. Incident Location Information (if different than section B. above)

Property Owner:

County:

Telephone:

Email:

Address:

City:

State:

Zip:

D. Complaint Details

Please provide as much detail as possible. The more information you provide, the easier it is for DNR to follow-up. Use Question 5. to provide any information you have beyond what is asked for in questions 1. to 4.

1. Please describe your complaint (include type(s) of waste involved and estimate of quantity of waste. For containers, indicate type, size and color, and whether material is leaking or getting onto the ground surface or into surface water.)

2. When did you become aware of the activity you are filing the complaint about, and how long do you believe it has been occurring?

3. Have you or someone you know previously registered a complaint with the Wisconsin Department of Natural Resources or some other governmental agency regarding this problem?

Yes

If yes, describe when and to whom the complaint was made:

4. What, if any, relationship do you have with the person and/or property owner listed in sections B and C above?

5. What additional information would help DNR follow-up on this complaint?