Bishop Tube Community Impacts Questionnaire
We continue to work to fully understand how people in our community are being impacted by the contamination at the Bishop Tube site. We want to be sure we are pursuing every opportunity to defend those who live around and/or downstream from the site that may have been impacted.

With this document, we are specifically seeking additional information on health and/or property impacts. If you believe your health or the use, enjoyment or value of your property, have been impacted by the contamination at Bishop Tube it would be very helpful if you could share your information in the below document.

We will not release any of this information with your name beyond the leadership team of our effort or legal counsel without your permission and knowledge.

Name *
Your answer
Address *
Your answer
Phone Number *
Your answer
Email Address *
Your answer
You believe the following have been adversely impacted by contamination at Bishop Tube: *
Health Impacts- please describe the health impacts you are concerned about:
Your answer
When was this condition diagnosed?
Your answer
By whom was this condition diagnosed?
When were you exposed to contaminants at or from Bishop Tube – provide as much information as you can recall in terms of dates of exposure, pathways for exposure, degree of exposure:
Your answer
What is the status of your health concern?
Your answer
Property Impacts- what is your property location as pertains to Bishop Tube (next door, downstream, down the road, can you give mileage as the crow flies)? Please give as much detail as possible:
Your answer
What is the nature of the impact? Please give as much detail as possible:
Your answer
How long have you been at this property?
Your answer
What information or documentation do you have to support your concerns?
Your answer
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