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AG/Pesticide Complaint Form

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Please correct the field(s) marked in red below:

Please complete your contact information:
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Please complete your contact information:

Provide the date and time of the incident:
Provide the date and time of the incident:

Provide the nature the complaint

Upload any documentation, pictures or video that would help us understand your complaint:
Upload any documentation, pictures or video that would help us understand your complaint:
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