Pollution and Dust Event Submission Form
Please use this form to submit a witnessed pollution or dust event that caused prolonged (ten minutes or longer) degraded air quality or reduced visibility. Your name and email will only be used to contact you for any clarification regarding the event. Fields marked with a (*) are required. Feel free to leave a URL link to a photo in the “Additional Description” section or email Wenshan Wang your photos at wenshanw@uci.edu.
Email address *
Name *
Pollution/Dust Event Starting Date *
MM
/
DD
/
YYYY
Pollution/Dust Event Approximate Starting Time *
Time
:
Pollution/Dust Event Ending Date
MM
/
DD
/
YYYY
Pollution/Dust Event Approximate Ending Time
Time
:
Approximate Location (please include latitude and longitude if possible, or roads, landmarks, and cardinal directions) *
Additional Description
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of University of California, Irvine. Report Abuse