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AZDWM
ARIZONA DEPARTMENT OF
WEIGHTS & MEASURES
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Heard about Department From:  *
If Other, Describe: 
Date of Occurrence:      2014 *
Time of Occurrence: 
 
Business Name:  *
Street Address/Crossroads:  *
City, State Zip:  *
 
Type of Complaint:  *
Complaint Description:  *
The Complaint Description is limited to 1000 characters (about 15 lines). Anything typed beyond the limit will not be recorded.
 
The following information may be required based on the complaint type selected.*
 
Fuel Pump #: 
Fuel Grade: 
Taxi License Plate #: 
Product Name/Description: 
 
Would you like to be contacted with the inspection results?
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Your Information
Your Name: 
Phone:     
Email Address: 

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