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2. First Name
3. Last Name
5. Address
7. Phone
8. E-Mail
10. Date and Time of Odor
    Date and Time of Odor Start Date

    Date and Time of Odor Start Time

    —

    Date and Time of Odor End Date

    Date and Time of Odor End Time
12. Description of Odor (What does it Smell Like)

    1. Rotten Eggs
    2. Ammonia
    3. Chemical
    4. Decayed Flesh
    5. Sharp, Pungent, Acid

    1. Sewer
    2. Burnt, Smokey
    3. Earthy, Musty
    4. Decayed Vegetables
13. Other
    Describe the odor in your own words.
15. What do you suspect is the source of the odor?
17. What is the Intensity of the Odor?

    1. Very Faint - Not Annoying
    2. Faint - A Little Annoying
    3. Noticeable - Annoying
    4. Strong - Very Annoying
    5. Very Strong - Extremely Annoying
19. What is the Wind Direction at Your Location?
21. What is the Wind Speed?

    1. Still - No Wind
    2. Light - 1-5 mph
    3. Medium - 6-10 mph
    4. Strong - >10 mph
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23. 1. Receive an email copy of this form.
24. Email address

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