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Odor Report Form

2. Title II Compliance
   In accordance with the requirements of Title II of the Americans with Disabilities Act (“ADA”) of 1990, the Fair Employment & Housing Act (“FEHA”), the Rehabilitation Act of 1973 (as amended), Government Code section 11135 and other applicable codes, the City of Modesto (“City”) will not discriminate against individuals on the basis of disability in the City’s services, programs, or activities. For more information, please visit the City of Modesto website.
4. First Name*
5. Last Name*
7. Location where odor was first observed*
9. Date/Time Odor was first observed*
   Date/Time Odor was first observed

   Date/Time Odor was first observed
10. Date/Time Odor was Last Observed*
    Date/Time Odor was Last Observed

    Date/Time Odor was Last Observed
12. Is the odor ongoing?*

    1. Yes
    2. No
13. Nature of Odor*

    1. Fecal / Sewery
    2. Ammonia / Fishy
    3. Rancid / Putrid
    4. Earthy / Musty
    5. Rotten Egg / Swampy or Marshy
    6. Other
14. If other please describe
16. Odor Intensity*

    1. 1 - Slight
    2. 2 - Noticeable
    3. 3 - Very Noticeable
    4. 4 - Strong
    5. 5 - Very Strong
17. Winds*

    1. Calm
    2. Light Breeze (1 - 5 MPH)
    3. Moderate Winds (5 - 15 MPH)
    4. Strong Winds (15+ MPH)
18. Wind Direction

    1. North
    2. North West
    3. West
    4. South West
    5. South
    6. South East
    7. East
    8. North East
20. Would you Like to be Contacted?*

    1. Yes
    2. No
21. Email address
22. Phone Number
24. Additional Comments
Leave This Blank:


26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit

* indicates a required field