LOUISIANA DEPARTMENT OF ENVIRONMENTAL QUALITY
Secretary Aurelia S. Giacometto









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CRIMINAL INVESTIGATION SECTION COMPLAINT FORM






Complaint Information

* Activity Date
* Parish of Activity
* Address of Activity
* City of Activity
* Complaint Type
* Complaint

Reporter Information

* First Name
* Last Name
Wish to Remain Anonymous?
Your Agency/Company
Your Address
Your City
Your State
Your Zip
* Your Phone Number
* Your Email

Responsible Party Information

First Name of Accused Person (if known)
Last Name of Accused Person (if known)
Name of Accused Agency/Company (if known)
Address of Accused (if known)
City of Accused (if known)
State of Accused (if known)
Zip of Accused (if known)
Accused Phone Number (if known)