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2. Name*
4. Address*
6. City*
7. State*
8. Zip Code*
10. Day Time Phone Number*
12. Email Address*
14. Nearest River System*
16. Level of Annoyance*

    1. Not Bad
    2. Moderate
    3. Extremely Bad
18. Short Description of Problem*
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20. 1. Receive an email copy of this form.
21. Email address

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