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|STATE OF CALIFORNIA-HEALTH AND HUMAN SERVICES AGENCY||
Jerry Brown, Governor
| DEPARTMENT OF ALCOHOL AND DRUG PROGRAMS
Office of External Affairs
1700 K STREET
SACRAMENTO, CA 95811-4037
TDD (800) 735-2929
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.
|PERSON FILING COMMENT/COMPLAINT:
|| WHICH ADP DIVISION/PROGRAM IS YOUR
| 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):
| HAVE YOU CONTACTED US BEFORE ON THIS MATTER? WHEN? WHO WAS YOUR CONTACT?
SIGNATURE ______________________________________ DATE__________________________