Microsoft Word - NOISE COMPLAINT REPORT

NOISE COMPLAINT REPORT

TO: Texas Military Forces, CFMO-Environmental Branch (NGTX-FE), 2200 W. 35th St, Austin TX 78703

1. Person Making Complaint: Date & Time of Complaint:___________________

Name: ________________________________ Phone: ( ____)______ - ___________

Address: ______________________________________________________________

City / Zip Code: ________________________________________________________

2. Disturbance: Date & Time of the disturbance: __________________/_________h

Facility where disturbance occurred: _______________________________________

Address: _______________________________________

City: __________________________________________

[ ] Aircraft [ ] Wheeled vehicle [ ] Training

[ ] Maintenance [ ] Other

Specific details concerning disturbance: _____________________________________

______________________________________________________________________

3. Name of person documenting complaint:___________________________________

Unit:___________________ Position / Title:__________________________________

Duty Phone: ( ___ )_____ - _________ ext: _________

Address: ______________________________________________________________

City / Zip Code: ________________________________________________________

4. REMARKS:

________________________________________________________________________

TXARNG FORM 95R, dated AUG 2014

Instructions for Noise Complaint Form

Box 1 WHO: Fill in the appropriate contact information of the person making the

complaint. Be sure to record the date and time of when the complaint is

actually received not when the disturbance took place. A name and phone

number are essential in case any follow up conversations are required.

Box 2 WHAT, WHEN, WHERE: Record the date, time and location of the

disturbance. Indicate the type of disturbance and all other details pertinent

to the complaint. Note if there were any negative consequences beyond

just hearing noise.

Box 3 YOUR INFORMATION: Identify your contact information so you can be

reached if there are any questions.

Box 4 Record all other remarks and information that are relevant to the noise

disturbance. If you happen to know how far away the person is from the

installation boundary or disturbance, please note here. If you happen to

know what activity (either TXMF or other entity) caused the complaint,

please note here.

Send a completed copies to:

Texas Military Forces

Public Affairs Office

Building 10 (NGTX-PA)

2200 W. 35th St, Austin TX 78703

Texas Military Forces

CFMO-Environmental Branch

Building 1 (NGTX-FE)

2200 W. 35th St, Austin TX 78703

Or Fax to Environmental at 512-782-5141.