Exit Odor Notification Form Thank you for notifying us of the odors you experienced. To enable the Western Placer Waste Management Authority and/or Placer County Air Pollution Control District to conduct a meaningful field investigation of the odor conditions, we encourage you to notify us (via this form) as close to the time that you experienced the odor as possible. Question Title * 1. When did you experience the odor? Today Yesterday Other (please specify in month/day/year format) Question Title * 2. Approximately what time did you first detect the odor? . Time AM/PM - AM PM Question Title * 3. Approximately how long did you experience the odor? Less than 5 minutes 5 to 15 minutes 15 to 30 minutes 30 minutes to 1 hour 1 to 2 hours more than 2 hours Currently experiencing the odor Other (please specify) Question Title * 4. Please describe the odor. Acrid (sharp/bitter/sour) Earthy/Musty Fishy Gassy Manure/Farm Animals Rotten Eggs Sewer Solvent/Chemical Trash Other (please specify) Question Title * 5. Please rate the intensity of the odor. 1 2 3 4 5 Please rate the intensity of the odor with "1" being mild and "5" being strong. Please rate the intensity of the odor with "1" being mild and "5" being strong. 1 Please rate the intensity of the odor with "1" being mild and "5" being strong. 2 Please rate the intensity of the odor with "1" being mild and "5" being strong. 3 Please rate the intensity of the odor with "1" being mild and "5" being strong. 4 Please rate the intensity of the odor with "1" being mild and "5" being strong. 5 Question Title * 6. Address and street name where you experienced the odor: Question Title * 7. Additional information or comments: Question Title * 8. To allow the greatest flexibility in contacting you to discuss the odor conditions, conducting a timely field investigation and to provide you with a summary of our investigation findings, please provide your name, telephone number (including area code) and email address in the spaces provided below: Name Telephone Number Email Address Please note that any information you provide on this form may be subject to public disclosure, including sharing with other regulatory or municipal agencies or their agents. Done