The County of Orange - Weights & Measures
Consumer Complaint (Service Stations, Markets, Recyclers & others)
Your Information Today's Date Your Name Your Address City & Zip Code Contact Phone 8 am to 5pm Mon-Fri
I have a Complaint Against Name of Business Address City & Zip Code Have you contacted the establishment? Yes No
Grievance Complaint because of: Over Charged Short Measure Underpaid Short Weight Short Count Scanner Error
Describe Complaint: Include Pump number, Octane number, Scale/Scanner Lane number etc.Nature of Hazard / Instructions
PLEASE SIGN ********* YOUR SIGNATURE __________________________________________________
ENCLOSE COPIES OF RECEIPTS AND MAIL OR FAX TO: Agricultrual Commissioner / Sealer of Weights & Measures 1750 South Douglass Rd. Building D Anaheim, CA 92806-6031 Fax # 714-567-6203
Phone 714-447-7100 Please type in the information, save, print and fax or mail this form.