Draft Health Consultation - Comment Form - New York State Department Of Health printable pdf download

Draft Health Consultation - Comment Form - New York State Department Of Health

New York State Department of Health

Draft Health Consultation - Comment Form

Dewey Loeffel Landfill Site

Thank you for reviewing the draft health consultation. The public comment period gives you a chance to let us know if you

have questions or additional information related to the site that should be included in this report. This reply form is broken

into three sections - optional information (to update our mailing list), general comments (how helpful is the information to

you) and specific comments (specific to the main sections in the report). Please write any questions or comments in the

appropriate spaces below.

Please return your completed form by February 29, 2012. Additional information and documents about this site can be

found at the New York State Department of Health (NYSDOH) website at:

Optional Information

First Name

Last Name

Address

Contact number (with best time to reach you)

E-mail Address

General Comments

1. Was the information in this health consultation clear and understandable? (Rate on a scale of 1 to 5, please circle

your choice)

Not clear and understandable

Very clear and understandable

2. Does the document take into account all relevant site information? (Check one)

Yes

Not sure

If no, please tell us what's missing

3. Does the document identify and respond to community concerns, including your own concerns? (Check one)

Yes

Not sure

If no, please tell us what concerns are missing

4. After reading this document, do you have a better understanding of how the site might affect your or your

community’s health? (Rate on a scale of 1 to 5, please circle your choice)

Do not have a better understanding

Have a much better understanding

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Draft Health Consultation - Comment Form - New York State Department Of Health