Home Services Consumer Health Complaint and Comment Form Complaint Type - Select -Food EstablishmentPools/Spa/SplashpadsWaste/Sewer OverflowPrivate Ambulance My complaint is on a... Restaurant Fast Food Place Mobile Unit (taco stand, etc.) Cafeteria Illegal Vendor Ice Cream Truck Store Other… Enter other… Establishment Name Address Establishment Address Address 2 City/Town State/Province - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon ZIP/Postal Code Contact Person Contact Information (optional) Name Email Phone Complaint Description Please provide a description of your complaint/comments: Mobile Unit Info 1 If this complaint is on a mobile food unit/vehicle/illegal vendor, include a detailed description of the mobile unit/vehicle and the license plate number Mobile Unit/Vehicle/Illegal Vendor Complaint Description License Plate Number Mobile Unit Info 2 If this complaint is on a mobile food unit/vehicle/illegal vendor, include the days and time of day that the mobile unit/vehicle/illegal vendor was observed Days Sunday Monday Tuesday Wednesday Thursday Friday Saturday Time of Day Morning Afternoon Evening Other… Enter other… CAPTCHA This question tests whether you are a human visitor and prevents automated spam submissions. Leave this field blank