Coal Tar Complaint Form

Please fill out Section 1 and describe the details of your complaint. If you would like DEC to be able to contact you regarding your complaint, please fill out Section 2. A complaint can be submitted without filling out any portion of Section 2. Once you have filled out the form, you will receive a confirmation email and DEC will contact you regarding your complaint (if applicable).

Section 1

Instructions: Please fill out Section 1 with the details of your complaint. Step 1 indicates if you’re submitting a complaint about a product or about an applicator. If submitting a complaint about a product, please provide details on the product name, where and when the product was found, and whether or not the product was purchased. An applicator is a person or company that applies pavement products to a driveway or parking area. If submitting a complaint about an applicator, please provide details on the name of the applicator, where the applicator was potentially applying pavement products containing coal tar, and any further evidence you may have on the situation.

Step 1 - What is being reported?

Step 2a (if reporting the discovery of a product)

Product Name

Store Name

Store Address

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

What was the date you observed the sale or offering for sale of this product?

Is the product labeled as containing coal tar?

If you purchased the product, do you still have it, or have you disposed of it?

Step 2b (if reporting an applicator)

Details of Company applying product

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Company Name

Company Phone

Location where product was being applied

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Do you know which pavement product is being used?

If No, please put N/A in the Product Name and Manufacturer/Brand fields below

Name of Product

Manufacturer/Brand

Do you know where this pavement product was obtained from?

If No, please put N/A in the Location Name field below.

Location Name

How do you know a coal tar product is being used?

Please be as specific as possible to help us substantiate your claim (conversation with applicator, label on truck, etc.). If possible, please upload any additional proof you may have.

Additional Info

Check this if you're submitting supporting pictures or video.

Please email any additional proof or evidence you have to [email protected]

Section 2

Instructions: You are not required to fill out Section 2 of this form and may file a complaint by only completing Section 1. However, providing contact information in Section 2 gives DEC the ability to contact you and follow up with you about your complaint. If you would like for DEC to be able to contact you regarding your complaint, please provide your contact information in Section 2.

Contact Information

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Prefer to be contacted by phone or email?

Phone Number or Email Address

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Coal Tar Complaint Form

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