INFORMAL COMPLAINT (Issues Other Than Noise Only) If you complete this informal complaint form and send it to the Clerk of the Board (100 W. Randolph St., Suite 11-500, Chicago, Illinois 60601), the Board will forward it to the Illinois Environmental Protection Agency (IEPA). The informal complaint form will constitute your request that IEPA conduct an informal investigation of the pollution you allege in the form. Another option you have is to directly inform IEPA of the alleged pollution. Either way, it is then up to IEPA to determine whether and how to investigate and address the alleged pollution. It is important that you provide as much information as you reasonably can about the alleged pollution (e.g., who is polluting and where the pollution is located; the type of pollution; how often the polluting happens and how long it lasts; how long the polluting has been going on). This information can help IEPA in any investigation it conducts. Please note, however, that IEPA no longer has the resources to investigate alleged noise pollution. IEPA may take any of several steps in response to your request. For example, IEPA may determine that there is a pollution problem and begin pre-enforcement activities that could result in the Illinois Attorney General or State’s Attorney filing an enforcement action against the alleged polluter. IEPA may determine that there was no pollution problem or that the problem has been resolved. IEPA also may determine that the pollution problem has not been resolved, but that IEPA is not in a position to proceed with pre-enforcement activities at the time. When the Board forwards your request to IEPA, the Board will send you a copy of the correspondence. IEPA is in turn required to send the Board an acknowledgement that it received your request. If you are not satisfied with IEPA’s response to your request, you may file a formal complaint with the Board against the alleged polluter. Requesting an informal investigation is not a prerequisite to filing a formal complaint. A formal complaint form is part of these materials. American LegalNet, Inc. www.USCourtForms.com STATE OF ILLINOIS POLLUTION CONTROL BOARD JAMES R. THOMPSON CENTER 100 W. RANDOLPH STREET, SUITE 11-500 CHICAGO, ILLINOIS 60601 INFORMAL COMPLAINT REQUEST FOR INFORMAL INVESTIGATION BY THE ILLINOIS ENVIRONMENTAL PROTECTION AGENCY (IEPA) (Issues Other Than Noise Only) 1. Your name, street address, county, state: ________________________________________ ________________________________________ ________________________________________ ________________________________________ Phone: _________________________________ 2. Place where you can be contacted during normal business hours (if different from above): ________________________________________ ________________________________________ ________________________________________ ________________________________________ Phone: _________________________________ 3. Name and address of alleged polluter: ________________________________________ ________________________________________ ________________________________________ ________________________________________ Phone: _________________________________ (if known) American LegalNet, Inc. www.USCourtForms.com 4. Type of pollution (check one or more): _____ _____ _____ _____ 5. Air (including odors) Water Garbage Sewer back-ups ______ ______ ______ Hazardous waste Drinking water Other, excluding noise (please describe) Describe in detail the source and location of pollution: _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ 6. Describe the duration of pollution, including when you first noticed the pollution, how frequently it occurs, and what season or time of day it occurs: _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ 7. Provide any additional information that might help IEPA in any investigation: _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ Note: The Board will forward this request to IEPA with a copy to the person requesting the informal investigation. IEPA must send the Board an acknowledgment that it received this request. See 35 Ill. Adm. Code 103.208. American LegalNet, Inc. www.USCourtForms.com