Fillable COMPLAINT/REFERRAL FORM Kansas Department of Health and Environment (Kansas Department of Health and Environment)

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COMPLAINT/REFERRAL FORM Kansas Department of Health and Environment (Kansas Department of Health and Environment)

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COMPLAINT/REFERRAL FORM
Kansas Department of Health and Environment - Division of Environment
Do you want to remain anonymous? Yes No
Your information
Name:
Address:
City:
Telephone:
Day: Evening:
Complaint information
First & Last Name:
Company Name:
Address:
City:
Zip: County:
Legal:
1/4
1/4 1/4
Sec.
Twp.
Range
Other Directions:
Describe the complaint, concern or issue:
Mail to: Bureau of Waste Management
ATTN: Brian Burbeck
1000 SW Jackson, Suite 320
Topeka, KS 66612-1366
785-296-1613
Or
Email to: rwenner@kdheks.gov
bburbeck@kdheks.gov
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COMPLAINTREFERRAL FORM Kansas Department of Health and Environment (Kansas Department of Health and Environment)

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Completed 20 July 2020

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