Please share your insight on air quality where you live and the action you would like to see taken to improve air quality.
Questions? Contact info@sustainablesolano.org

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* 1. Name

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* 2. Email

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* 3. Telephone number

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* 4. Preferred method of contact

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* 5. Which city do you live in? (if you live in unincorporated Solano, which city is the closest to you)?

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* 6. What zip code do you live in?

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* 7. Which language is primarily used in your household?

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* 8. How many people live in your household (adults and children)?

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* 9. Do you think there is a problem with air quality in your city on a scale of 1 - 5?

1 -  No issue with air quality locally 3 - There are some issues with air quality locally 5 - There are major issues with air quality locally
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i We adjusted the number you entered based on the slider’s scale.

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* 10. How often does air quality impact your daily life?

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* 11. Do you or anyone in your household have a condition that is worsened by poor air quality (e.g. asthma, cardiovascular disease, etc.)?

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* 12. What sources of air pollution in your city concern you? (Choose all that apply)

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* 13. What are you most interested in learning more about regarding air quality? (Choose up to three major priorities)

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* 14. Which actions are the highest priority for you? (Choose your three top priorities)

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* 15. Optional: How do you want to be involved in improving your city’s air quality? (select all that apply)

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* 16. What haven't we addressed in the above questions that you would like to see reflected in an air quality action plan or would like for your city and county leaders to know about air quality?

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