2. Name (First, Last)*
3. Email Address*
5. Address
6. Phone Number
8. Date of Occurrence
   Date of Occurrence
9. Type of Service
11. Type of Service

    1. Transfer Station
    2. Landfill
    3. Curbside Pickup
    4. Recycling
    5. Other
13. Description of Complaint or Issue
15. Suggestion (or desired outcome)
17. Would you like to be contacted

    1. Yes by phone
    2. Yes by email
    3. Not needed at this time
19. Thank you for taking your time to give us feedback on your experience. We appreciate it! If you need further assistance please call us at (509) 773-4448
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21. 1. Receive an email copy of this form.
22. Email address

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23. Submit

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