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* 1. Please enter your contact information below:

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* 2. Please describe your role in the community (check all that apply):

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* 3. Please select your preferred method of communication (check all that apply):

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* 4. Where do people meet to share information in your community?  (check all that apply):

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* 5. What is your understanding of the Clayton Cleaners site? (Please describe):

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* 6. Please tell us what you would like to know more about relating to the Clayton Cleaners Site (check all that apply):

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* 7. Do you have any unique concerns or barriers to communication that might limit your participation in the decision making process?

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* 8. Do you have information regarding the Clayton Cleaners Site you feel would benefit the department's efforts to protect human health and the environment?  Please describe.

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