CPV Health Impact Form
Please enter and record any and all health impacts or other impacts experienced from the CPV Valley Power Plant
Best contact phone number
Full Name and Address
About how far do you live from the plant
How old are you?
How many people live in your household/ages of each.
Did you experience any of the below since January 19th?
Please list approximate dates and times for each impact you experienced.
Other symptoms or impacts (please describe in detail)
Send me a copy of my responses.
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