Type of Inquiry: * Inquiry/Question Request for Assistance Report a Concern Comment/Compliment

Your Name: 

Your Phone:  

Your E-mail:  

Your Street Address:  

City:       Zip Code:  

If you have a question, use this box to ask us.  Then fill in NA into the required fields * below and click Submit.  For the county field select your county.

If you have a concern, please use the boxes below.

We appreciate your assistance and concern about the protection of the environment. To assist us in following up on your concern, please complete this form. Please try to include as much information as possible about the issue (names, addresses, dates, who, what, when, where, etc.) and how you were able to find out about this issue.

Do you wish to be notified as to the outcome of our investigation? If you don't give us enough contact information above we cannot notify you.

Yes    No

Date you observed the issue: *

County: * Select Adair Andrew Atchison Audrain Barry Barton Bates Benton Bollinger Boone Buchanan Butler Caldwell Callaway Camden Cape Girardeau Carroll Carter Cass Cedar Chariton Christian Clark Clay Clinton Cole Cooper Crawford Dade Dallas Daviess Dekalb Dent Douglas Dunklin Franklin Gasconade Gentry Greene Grundy Harrison Henry Hickory Holt Howard Howell Iron Jackson Jasper Jefferson Johnson Knox Laclede Lawrence Lewis Lincoln Linn Livingston McDonald Macon Madison Maries Marion Mercer Miller Mississippi Moniteau Monroe Montgomery Morgan New Madrid Newton Nodaway Oregon Osage Ozark Pemiscot Perry Pettis Phelps Pike Platte Polk Pulaski Putnam Ralls Randolph Ray Reynolds Ripley St. Charles St. Clair St. Francois Ste. Genevieve St. Louis City of St. Louis Saline Schuyler Scotland Scott Shannon Shelby Stoddard Stone Sullivan Taney Texas Vernon Warren Washington Wayne Webster Worth Wright    Nearest City  (optional)

Detailed driving directions to the concern: *

Name of facility/business or person the concern is about: *

Facility contact name:

Facility contact address:

Facility contact phone:

Comments: *

In the Comments blank describe your request. If you are reporting an environmental concern, describe location of concern from nearest town and road intersection.

For an environmental concern, be as specific as possible, including the distance from road and whether the concern is visible from the road. Describe landmarks such as nearby streams, buildings and roads to help locate the dumpsite or other concern. Please try to include as much information as possible about the issue (names, addresses, dates, who, what, when, where, etc.) and how you were able to find out about this issue. If you choose to be anonymous, we won't be able to provide feedback or we may not be able to proceed with a full investigation if we do not have enough information.

If you have contacted a state or local agency regarding this issue, please note the name of the agency and a contact person (if known) in the box below. (optional)