Bayer Lanxess Plastics Pollution log Please use this log to record pollution you experience in your neighborhood or at home. Keeping a log of what you experience is one way to collect evidence the polluter cannot deny. Name ___________________________ Address _____________________________________ Telephone ______________________ Email _______________________________

Date Time What you observed (smoke, fire, particles, smell, vibration, noise . . .) How were you affected? Example: 07/07/04 3 AM A rotten egg smell Hard to breathe

Please print this form. When you have filled it out, please mail it to -- Ohio Citizen Action 2330 Victory Parkway, Suite 305 Cincinnati, OH 45206 Or fax to (513) 221-2102. To register a complaint about air pollution, call -- Hamilton County Department of Environmental Services, (513) 946-7777 or (800) 889-0474.