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Odor Report Form
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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
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First Name
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Last Name
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Location where odor was first observed
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Date/Time Odor was first observed
*
Date/Time Odor was first observed
Date/Time Odor was first observed
Date/Time Odor was Last Observed
*
Date/Time Odor was Last Observed
Date/Time Odor was Last Observed
Is the odor ongoing?
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Yes
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Nature of Odor
*
Fecal / Sewery
Ammonia / Fishy
Rancid / Putrid
Earthy / Musty
Rotten Egg / Swampy or Marshy
Other
If other please describe
Odor Intensity
*
1 - Slight
2 - Noticeable
3 - Very Noticeable
4 - Strong
5 - Very Strong
Winds
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Calm
Light Breeze (1 - 5 MPH)
Moderate Winds (5 - 15 MPH)
Strong Winds (15+ MPH)
Wind Direction
North
North West
West
South West
South
South East
East
North East
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