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 (Wheel Mounted – e.g., cart on wheels, trucks, trailers, etc. ) Cafeteria Illegal Vendor (non-wheel mounted- e.g.,, tables, tenets, taco stands, etc) 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