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Fill and Sign the Healthy Blue Amerigroup Scholarship Application Sowela Form

Fill and Sign the Healthy Blue Amerigroup Scholarship Application Sowela Form

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SAN LUIS OBISPO COUNTY WEIGHTS AND MEASURES COMPLAINT FORM To best assist you in resolving your problem, we will need to collect information, such as your name, contact information, and details of your complaint. Please fill out the following form and submit it to the San Luis Obispo County Department of Agriculture/Weights and Measures, 2156 Sierra Way, Suite A, San Luis Obispo, CA 93401. You may attach additional pages and/or related documents as appropriate. YOUR CONTACT INFORMATION Your name: Your address (optional): Telephone number (should we need additional information): Preferred time to be contacted: Would you like us to contact you with the results of our investigation? How? Email address (optional): INFORMATION YOU HAVE ABOUT THE BUSINESS Business name: Physical address: City: Telephone number: Name and/or description of owner or employee: Date and time problem occurred: Where did it happen? Did you retain a receipt, bill or statement? WHAT IS YOUR COMPLAINT? Describe the nature of your complaint. Write down the events leading to it in the order in which they happened. Please include specific dates, times, individuals you dealt with and the actions you took. Who else have you contacted regarding this matter? What would you like to see done? What is your proposed solution? Office use only Date complaint was received: reviewed by:

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