State of California

Department of Toxic Substances Control







1) How long have you lived or worked in the area?


__ 0‑5 years __ 6‑12 years __ 13‑20 years __ 21 or more years


2) Prior to reading the letter, were you aware of the site's condition?

__ YES __ NO


If YES, where did you acquire your prior knowledge about the site?


__ Newspapers __ Neighbors __ Relatives

__ Other (Please specify source, especially if you have information about the early history of the site. Attach additional pages as needed):


3) What is your current level of interest in this site?


__ None __ Low to moderate __ Moderate to high


4) Do you have any specific concerns about this site or project? If so, please describe:


5) Have you had any contact with local, state or other officials regarding this site?

__ YES If YES, please describe:

__ NO


6) Have you had any contact with the owners of this site or those responsible for its cleanup?

__ YES If YES, please describe:

__ NO


Please continue on the backside

7) Are you interested in receiving information about the investigation and future work?

__ YES If YES, what is the best way? __ Fact Sheets or Letters

__ NO __ Community Meetings

__ Other (please specify)


8) What languages are spoken in your community?


If you named a language besides English, do you feel that future communication to community

members regarding this site should be written in this language? __ YES __ NO


9) Can you suggest any other person or groups that might be interested in receiving information about this site or the work proposed for it?



10) Please let us know of any other comments or questions.


11) If you are interested in being added or taken off the mailing list for information related to ITT Cannon Humboldt Street Property site, please check the appropriate line and return to the

address below.

__ Please place me on the mailing list for future materials on this site.

__ Please remove my name from the mailing list.


Name: Place






Telephone No.:


Please mail this document to:


Department of Toxic Substances Control

5796 Corporate Avenue

Cypress, CA 90630

Attn: Leticia Hernandez, Public Participation Specialist




Please fold the letter with the address showing, place stamp on the right‑hand side and staple or seal, thank you.