File A Citizen Complaint

Do Not Use This Form For Anonymous Complaints

To submit an anonymous complaint, please call the Single Point of Contact at

(225)219-3640 Monday-Friday 8:00AM - 4:30PM

If this is a Radiological Complaint/Incident/Allegation

STOP NOW and IMMEDIATELY CALL

the LDEQ Radiation Services hotline @ 225-765-0160

(In accordance with Louisiana Regulatory Requirements)

Caller Information

* First Name

* Last Name

* Phone Number

Mailing Address

City

* State

Zip

I request a follow-up on inspector findings

yes

Alleged Violator

* Physical Location/ Address

* City

* State

* Zip

Date of Discharge

Noticed Time Began

Noticed Time Ended

Parish of Occurrence

Media Affected

If water, name the nearest water body

Description of complaint

Directions for reaching the site