SlideShare a Scribd company logo
1 of 2
Download to read offline
Citizen Interview Questionnaire
                                     for the Cabot Koppers Site
Name:_____________________________________________________________________________

Address: __________________________________________________________________________

Home Phone: (        ) ______________________ Cell Phone: (          ) _______________________

E-Mail Address: ____________________________________________ Date: __________________


Are you aware of the site?


        How did you learn about the site?



Have you had concerns about the site in the past?


        Do you have any current concerns about the site?




Have you had any contact with local, state, or federal agencies about the site?


        Were you satisfied with the information provided?



Have you had any problems on your property that you think are attributable to site activities?



Have you been involved in any activities regarding the site?



        If not, would you like to be involved in activities regarding the site?



How would you like to be informed concerning site activities (mail, e-mail, telephone, newspapers, television, and
radio)?


May we have your permission to include your name and address on the site mailing list?


If EPA were to have a public meeting or availability session, what day and time would be most convenient for
you?


Can you identify possible places for future public meetings?
Are there any additional questions that you have concerning the Site, suggestions, or comments that
we should include in the Community Involvement Plan/Communication Strategy?

More Related Content

Similar to Questionnaire for july 8th intvws focus group

instructor-application-for-website-updated-july-2011
instructor-application-for-website-updated-july-2011instructor-application-for-website-updated-july-2011
instructor-application-for-website-updated-july-2011
Dixie Breidenstein
 
Lanford Family Highway Worker Memorial Scholarship Contribution
Lanford Family Highway Worker Memorial Scholarship ContributionLanford Family Highway Worker Memorial Scholarship Contribution
Lanford Family Highway Worker Memorial Scholarship Contribution
artba
 
Web page application
Web page applicationWeb page application
Web page application
CHu Di
 
2014 booth application
2014 booth application2014 booth application
2014 booth application
Rebecca Milkey
 
Project Smile, funded ECA of the U.S. Department of State
Project Smile, funded ECA of the U.S. Department of StateProject Smile, funded ECA of the U.S. Department of State
Project Smile, funded ECA of the U.S. Department of State
Inna Rakhmanova
 
Application For Certified Copy Of Birth Certificat
Application For Certified Copy Of Birth CertificatApplication For Certified Copy Of Birth Certificat
Application For Certified Copy Of Birth Certificat
buckbre
 
CREED Volunteer Application
CREED Volunteer Application CREED Volunteer Application
CREED Volunteer Application
deteezy
 

Similar to Questionnaire for july 8th intvws focus group (20)

App for assist for web
App for assist for webApp for assist for web
App for assist for web
 
AGC - Application
AGC - ApplicationAGC - Application
AGC - Application
 
instructor-application-for-website-updated-july-2011
instructor-application-for-website-updated-july-2011instructor-application-for-website-updated-july-2011
instructor-application-for-website-updated-july-2011
 
Lanford Family Highway Worker Memorial Scholarship Contribution
Lanford Family Highway Worker Memorial Scholarship ContributionLanford Family Highway Worker Memorial Scholarship Contribution
Lanford Family Highway Worker Memorial Scholarship Contribution
 
Order
OrderOrder
Order
 
Consult forms
Consult formsConsult forms
Consult forms
 
Web page application
Web page applicationWeb page application
Web page application
 
CHA Student Internship Program Application Summer 2013
CHA Student Internship Program Application Summer 2013CHA Student Internship Program Application Summer 2013
CHA Student Internship Program Application Summer 2013
 
Bully Prevention Alliance Volunteer Application
Bully  Prevention  Alliance  Volunteer  ApplicationBully  Prevention  Alliance  Volunteer  Application
Bully Prevention Alliance Volunteer Application
 
Mindat christian fellowships
Mindat christian  fellowshipsMindat christian  fellowships
Mindat christian fellowships
 
International student enrollment form TBA
International student enrollment form TBAInternational student enrollment form TBA
International student enrollment form TBA
 
TBEJobsiteForm2015
TBEJobsiteForm2015TBEJobsiteForm2015
TBEJobsiteForm2015
 
2014 booth application
2014 booth application2014 booth application
2014 booth application
 
Rent-To-Own Application
Rent-To-Own ApplicationRent-To-Own Application
Rent-To-Own Application
 
Project Smile, funded ECA of the U.S. Department of State
Project Smile, funded ECA of the U.S. Department of StateProject Smile, funded ECA of the U.S. Department of State
Project Smile, funded ECA of the U.S. Department of State
 
MVFC Member Agree PDF Form
MVFC Member Agree PDF FormMVFC Member Agree PDF Form
MVFC Member Agree PDF Form
 
Volunteer security application
Volunteer security applicationVolunteer security application
Volunteer security application
 
Application For Certified Copy Of Birth Certificat
Application For Certified Copy Of Birth CertificatApplication For Certified Copy Of Birth Certificat
Application For Certified Copy Of Birth Certificat
 
CREED Volunteer Application
CREED Volunteer Application CREED Volunteer Application
CREED Volunteer Application
 
Application to rent apartment
Application to rent apartmentApplication to rent apartment
Application to rent apartment
 

More from Protect Gainesville's Citizens

Off site koppers soil fact sheet 9-10_2010 - print ready
Off site koppers soil fact sheet 9-10_2010 - print readyOff site koppers soil fact sheet 9-10_2010 - print ready
Off site koppers soil fact sheet 9-10_2010 - print ready
Protect Gainesville's Citizens
 
1658 city of gainesville s pearson comments on fdep memo on koppers on site r...
1658 city of gainesville s pearson comments on fdep memo on koppers on site r...1658 city of gainesville s pearson comments on fdep memo on koppers on site r...
1658 city of gainesville s pearson comments on fdep memo on koppers on site r...
Protect Gainesville's Citizens
 
1658 acepd comments to usepa re interim stormwater design workplan 6 14-2010
1658 acepd comments to usepa re interim stormwater design workplan 6 14-20101658 acepd comments to usepa re interim stormwater design workplan 6 14-2010
1658 acepd comments to usepa re interim stormwater design workplan 6 14-2010
Protect Gainesville's Citizens
 
1658 amec beazer updated human health risk assessment koppers appendices 5 ...
1658 amec beazer updated human health risk assessment koppers appendices   5 ...1658 amec beazer updated human health risk assessment koppers appendices   5 ...
1658 amec beazer updated human health risk assessment koppers appendices 5 ...
Protect Gainesville's Citizens
 
1658 amec beazer updated human health risk assessment koppers text tables-fig...
1658 amec beazer updated human health risk assessment koppers text tables-fig...1658 amec beazer updated human health risk assessment koppers text tables-fig...
1658 amec beazer updated human health risk assessment koppers text tables-fig...
Protect Gainesville's Citizens
 

More from Protect Gainesville's Citizens (20)

Koppers proposed plan transcript 8 5 2010
Koppers proposed plan transcript 8 5  2010Koppers proposed plan transcript 8 5  2010
Koppers proposed plan transcript 8 5 2010
 
Public comment sheet
Public comment sheetPublic comment sheet
Public comment sheet
 
Off site koppers soil fact sheet 9-10_2010 - print ready
Off site koppers soil fact sheet 9-10_2010 - print readyOff site koppers soil fact sheet 9-10_2010 - print ready
Off site koppers soil fact sheet 9-10_2010 - print ready
 
Ron Hites Dioxin Article
Ron Hites Dioxin Article Ron Hites Dioxin Article
Ron Hites Dioxin Article
 
1658 city of gainesville s pearson comments on fdep memo on koppers on site r...
1658 city of gainesville s pearson comments on fdep memo on koppers on site r...1658 city of gainesville s pearson comments on fdep memo on koppers on site r...
1658 city of gainesville s pearson comments on fdep memo on koppers on site r...
 
Cpb 100923 agenda final
Cpb 100923 agenda finalCpb 100923 agenda final
Cpb 100923 agenda final
 
Public Comment Period Extended to October 15, 2010
Public Comment Period Extended to October 15, 2010Public Comment Period Extended to October 15, 2010
Public Comment Period Extended to October 15, 2010
 
Upper Floridan Aquifer IRM Water Quality Results for Groundwater Extraction a...
Upper Floridan Aquifer IRM Water Quality Results for Groundwater Extraction a...Upper Floridan Aquifer IRM Water Quality Results for Groundwater Extraction a...
Upper Floridan Aquifer IRM Water Quality Results for Groundwater Extraction a...
 
Meeting announcement - LIT Meeting August 17, 2010
Meeting announcement - LIT Meeting August 17, 2010Meeting announcement - LIT Meeting August 17, 2010
Meeting announcement - LIT Meeting August 17, 2010
 
Draft Community Invol august 2010 rev2
Draft Community Invol august 2010 rev2Draft Community Invol august 2010 rev2
Draft Community Invol august 2010 rev2
 
Risk Assessment Presentation
Risk Assessment PresentationRisk Assessment Presentation
Risk Assessment Presentation
 
This is a Superfund
This is a SuperfundThis is a Superfund
This is a Superfund
 
Community101
Community101Community101
Community101
 
EPA Superfund Proposed Plan Cabot / Koppers Superfund Site
EPA Superfund Proposed Plan Cabot / Koppers Superfund SiteEPA Superfund Proposed Plan Cabot / Koppers Superfund Site
EPA Superfund Proposed Plan Cabot / Koppers Superfund Site
 
1658 acepd comments to usepa re interim stormwater design workplan 6 14-2010
1658 acepd comments to usepa re interim stormwater design workplan 6 14-20101658 acepd comments to usepa re interim stormwater design workplan 6 14-2010
1658 acepd comments to usepa re interim stormwater design workplan 6 14-2010
 
Short termim workplan_20100602_part3
Short termim workplan_20100602_part3Short termim workplan_20100602_part3
Short termim workplan_20100602_part3
 
Short termim workplan_20100602_part2
Short termim workplan_20100602_part2Short termim workplan_20100602_part2
Short termim workplan_20100602_part2
 
Short termim workplan_20100602_part1
Short termim workplan_20100602_part1Short termim workplan_20100602_part1
Short termim workplan_20100602_part1
 
1658 amec beazer updated human health risk assessment koppers appendices 5 ...
1658 amec beazer updated human health risk assessment koppers appendices   5 ...1658 amec beazer updated human health risk assessment koppers appendices   5 ...
1658 amec beazer updated human health risk assessment koppers appendices 5 ...
 
1658 amec beazer updated human health risk assessment koppers text tables-fig...
1658 amec beazer updated human health risk assessment koppers text tables-fig...1658 amec beazer updated human health risk assessment koppers text tables-fig...
1658 amec beazer updated human health risk assessment koppers text tables-fig...
 

Recently uploaded

Finding Java's Hidden Performance Traps @ DevoxxUK 2024
Finding Java's Hidden Performance Traps @ DevoxxUK 2024Finding Java's Hidden Performance Traps @ DevoxxUK 2024
Finding Java's Hidden Performance Traps @ DevoxxUK 2024
Victor Rentea
 

Recently uploaded (20)

Portal Kombat : extension du réseau de propagande russe
Portal Kombat : extension du réseau de propagande russePortal Kombat : extension du réseau de propagande russe
Portal Kombat : extension du réseau de propagande russe
 
JohnPollard-hybrid-app-RailsConf2024.pptx
JohnPollard-hybrid-app-RailsConf2024.pptxJohnPollard-hybrid-app-RailsConf2024.pptx
JohnPollard-hybrid-app-RailsConf2024.pptx
 
AI in Action: Real World Use Cases by Anitaraj
AI in Action: Real World Use Cases by AnitarajAI in Action: Real World Use Cases by Anitaraj
AI in Action: Real World Use Cases by Anitaraj
 
Modernizing Legacy Systems Using Ballerina
Modernizing Legacy Systems Using BallerinaModernizing Legacy Systems Using Ballerina
Modernizing Legacy Systems Using Ballerina
 
Design and Development of a Provenance Capture Platform for Data Science
Design and Development of a Provenance Capture Platform for Data ScienceDesign and Development of a Provenance Capture Platform for Data Science
Design and Development of a Provenance Capture Platform for Data Science
 
ADP Passwordless Journey Case Study.pptx
ADP Passwordless Journey Case Study.pptxADP Passwordless Journey Case Study.pptx
ADP Passwordless Journey Case Study.pptx
 
Working together SRE & Platform Engineering
Working together SRE & Platform EngineeringWorking together SRE & Platform Engineering
Working together SRE & Platform Engineering
 
Navigating Identity and Access Management in the Modern Enterprise
Navigating Identity and Access Management in the Modern EnterpriseNavigating Identity and Access Management in the Modern Enterprise
Navigating Identity and Access Management in the Modern Enterprise
 
Choreo: Empowering the Future of Enterprise Software Engineering
Choreo: Empowering the Future of Enterprise Software EngineeringChoreo: Empowering the Future of Enterprise Software Engineering
Choreo: Empowering the Future of Enterprise Software Engineering
 
Overview of Hyperledger Foundation
Overview of Hyperledger FoundationOverview of Hyperledger Foundation
Overview of Hyperledger Foundation
 
Web Form Automation for Bonterra Impact Management (fka Social Solutions Apri...
Web Form Automation for Bonterra Impact Management (fka Social Solutions Apri...Web Form Automation for Bonterra Impact Management (fka Social Solutions Apri...
Web Form Automation for Bonterra Impact Management (fka Social Solutions Apri...
 
Design Guidelines for Passkeys 2024.pptx
Design Guidelines for Passkeys 2024.pptxDesign Guidelines for Passkeys 2024.pptx
Design Guidelines for Passkeys 2024.pptx
 
Introduction to FIDO Authentication and Passkeys.pptx
Introduction to FIDO Authentication and Passkeys.pptxIntroduction to FIDO Authentication and Passkeys.pptx
Introduction to FIDO Authentication and Passkeys.pptx
 
Quantum Leap in Next-Generation Computing
Quantum Leap in Next-Generation ComputingQuantum Leap in Next-Generation Computing
Quantum Leap in Next-Generation Computing
 
Finding Java's Hidden Performance Traps @ DevoxxUK 2024
Finding Java's Hidden Performance Traps @ DevoxxUK 2024Finding Java's Hidden Performance Traps @ DevoxxUK 2024
Finding Java's Hidden Performance Traps @ DevoxxUK 2024
 
CNIC Information System with Pakdata Cf In Pakistan
CNIC Information System with Pakdata Cf In PakistanCNIC Information System with Pakdata Cf In Pakistan
CNIC Information System with Pakdata Cf In Pakistan
 
Introduction to use of FHIR Documents in ABDM
Introduction to use of FHIR Documents in ABDMIntroduction to use of FHIR Documents in ABDM
Introduction to use of FHIR Documents in ABDM
 
Continuing Bonds Through AI: A Hermeneutic Reflection on Thanabots
Continuing Bonds Through AI: A Hermeneutic Reflection on ThanabotsContinuing Bonds Through AI: A Hermeneutic Reflection on Thanabots
Continuing Bonds Through AI: A Hermeneutic Reflection on Thanabots
 
Platformless Horizons for Digital Adaptability
Platformless Horizons for Digital AdaptabilityPlatformless Horizons for Digital Adaptability
Platformless Horizons for Digital Adaptability
 
Repurposing LNG terminals for Hydrogen Ammonia: Feasibility and Cost Saving
Repurposing LNG terminals for Hydrogen Ammonia: Feasibility and Cost SavingRepurposing LNG terminals for Hydrogen Ammonia: Feasibility and Cost Saving
Repurposing LNG terminals for Hydrogen Ammonia: Feasibility and Cost Saving
 

Questionnaire for july 8th intvws focus group

  • 1. Citizen Interview Questionnaire for the Cabot Koppers Site Name:_____________________________________________________________________________ Address: __________________________________________________________________________ Home Phone: ( ) ______________________ Cell Phone: ( ) _______________________ E-Mail Address: ____________________________________________ Date: __________________ Are you aware of the site? How did you learn about the site? Have you had concerns about the site in the past? Do you have any current concerns about the site? Have you had any contact with local, state, or federal agencies about the site? Were you satisfied with the information provided? Have you had any problems on your property that you think are attributable to site activities? Have you been involved in any activities regarding the site? If not, would you like to be involved in activities regarding the site? How would you like to be informed concerning site activities (mail, e-mail, telephone, newspapers, television, and radio)? May we have your permission to include your name and address on the site mailing list? If EPA were to have a public meeting or availability session, what day and time would be most convenient for you? Can you identify possible places for future public meetings?
  • 2. Are there any additional questions that you have concerning the Site, suggestions, or comments that we should include in the Community Involvement Plan/Communication Strategy?