Licensing
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| STATE OF CALIFORNIA-HEALTH AND HUMAN SERVICES AGENCY | Arnold Schwarzenegger, Governor |
 DEPARTMENT OF ALCOHOL AND DRUG PROGRAMS Office of External Affairs 1700 K STREET SACRAMENTO, CA 95811-4037 TDD (916) 445-1942 COMMENT/COMPLAINT FORM Section 8331(a) of the Government Code requires that State Agencies provide a form through which individuals can register complaints or comments relating to the performance of that Agency.
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| PERSON FILING COMMENT/COMPLAINT: |
WHICH ADP DIVISION/PROGRAM IS YOUR COMMENT/COMPLAINT ABOUT? |
| ADDRESS (Number and Street): |
PERSON WITH WHOM YOU DEALT: |
| CITY, STATE, ZIP: |
LOCATION OF ABOVE: |
| TELEPHONE NUMBERS (daytime, with area code): |
FAX NUMBER/E-MAIL ADDRESS (if any): |
| STATE YOUR COMMENT/COMPLAINT (Be specific - who, what, when, where, how; attach additional pages if needed): |
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| HAVE YOU CONTACTED US BEFORE ON THIS MATTER? WHEN? WHO WAS YOUR CONTACT? |
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| SIGNATURE ______________________________________ DATE__________________________ |
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