RECE~VED

State of Illinois

CLERK’S OFFICE

POLLUTION CONTROL BOARD

JAMES R.

THOr~IPsoN

CENTER

100

W. RANDOLPH STREET,

SUITE 11-500

STATE

OF

ILLINOIS

CHIcAGo, ILLINOIs

60601

Pollution Control Board

BEFORE THE

ILLINOIS POLLUTION CONTROL

BOARD

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__________________________________________________________________

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(Insert your name(s) on lines

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above),

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Complainant(s),

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v.

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(For Board use)

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(Insert name(s) of alleged

polluter(s)

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on lines above),

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Respondent(s).

)

Note:

Ifyou do not use this formal complaint form and instead draft and type your own, it must

contain all ofthe information requested by this form.

All items must be completed.

Ifthere is

insufficient space to

complete any item, you may attach additional sheets, specifying the number

ofthe item

you are completing.

Once completed, you must file the original and nine copies of

the formal complaint, notice to respondent, and certificate ofservice with the Clerk of the Board

at the above

address.

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Your

name, street address,

county, state:

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2.

Place where you can be

contacted during normal

business hours (if

different

from above):

3.

Name and address ofrespondent

(alleged polluter):

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(if known)

4.

Describe the type ofbusiness or activity that you allege is causing or allowing pollution

(e.g., manufacturing company, home repair shop) and give the address ofthe pollution

source if different than the address above:

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5.

List specific sections ofthe Environmental Protection Act,

Board regulations, Board

order, or permit that you allege have been or are being violated:

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6.

Describe the type ofpollution

that you allege

(e.g.,

air, odor, noise,

water, sewer back-

ups, hazardous waste) and the location ofthe alleged pollution.

Be

as specific as you

reasonably can in describing the alleged pollution:

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7.

Describe the duration and

frequency ofthe alleged pollution.

Be as specific as you

reasonably can about when you first noticed

the alleged pollution, how frequently it

occurs, and whether it is still continuing (include seasons ofthe year, dates, and times of

day if known):

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8.

Describe any bad

effects that you believe the alleged pollution has or has had

on human

health,

on plant or animal life, on the environment, on the enjoyment oflife or property,

or on any lawful business or activity:

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9.

Describe the relief that you

seek from the Board

(e.g.,

an

order that the respondent stop

polluting, take pollution abatement measures, perform a cleanup, reimburse cleanup costs,

change its

operation, or pay a civil penalty (note that the Board cannot order the

respondent to pay your attorney fees or any out-of-pocket expenses

that you

incur by

pursuing an

enforcement action)):

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10.

Identify any identical or substantially similar case you know ofthat

is already pending

before the Board or in

another forum against this respondent for the same alleged

pollution (note that you need not include any

complaints made to the Illinois

Environmental Protection Agency or any unit oflocal government):

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11.

State whether you are representing (a) yourself as an individual or (b) your

unincorporated sole proprietorship.

Also, state whether you are an

attorney and, if so,

whether you are licensed and registered to practice law in Illinois.

(Under Illinois law, an

association, citizens group, unit oflocal government, or corporation must be represented

before the Board by an attorney.

Also, an individual who is not an attorney cannot

represent another individual or other individuals before the Board.

However, an

individual who is not an

attorney is allowed to

represent (a) himself orherself as an

individual or (b) his or her unincorporated sole proprietorship, though the individual may

prefer having attorney representation.):

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12.

(Complainant’s signature)

CERTIFICATION

(optional

but encouraged)

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on oath or

affirmation, state that

I have read the foregoing and that it is accurate to the best ofmy

knowledge.

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(Complainant s

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Subscribed

to

and

sworn before me

this

day

of

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My

commission expires7)~1)//

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SENDER:

COMPLETE THIS SECTION

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Complete items 1, 2, and 3. Also complete

item

4 if Restricted Delivery is desired.

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Print your name and

address on the reverse

so that we can return the card to you.

•

Attach this card to the back of the mailpiece,

or on the front

if space permits.

1.

Article

Addressed to:

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4.

RestrIcted

Delivery?

(Extra Fee)

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Yes

2.

Article Number

(Transfer from service

label)

PS

Form

3811,

February

2004

?001

2510 0005

4531 22~?

Domestic

Return Receipt

102595-02-M-1540

POSTi~LSER(llCE

*****

WELCOME

TO

*****

MONEE

POST

OFFICE

MONEE

IL

60449—8101

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Cashier

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SERVICES

Certified Mail

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Subtotal

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Cash

Change Due

Cash

60449

2.50 oz,

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4.88

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230

1 .75

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Thank You

Please come again!

OF ILLINOIS

Control Board

3.

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Certified Mail

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Return

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C.O.D.

_________________

---

NOTICE

TO RESPONDENT

NOTE:

THIS STATEMENT MUST BE INCLUDED IN THE SERVICE OF THE

INFORMATION FOR RESPONDENT RECEIVING FORMAL COMPLAINT

Please take notice that today I filed with the Clerk ofthe Illinois Pollution Control Board

(Board) a formal complaint, a copy of which is served on you along with this notice.

You may

be required to attend

a hearing on a date set by the Board.

Information about theformal complaint process before the Board is found in the

Environmental

Protection Act (Act)

(415 ILCS 5/1

et seq.)

and the Board’s procedural

rules (35

Ill. Adm.

Code

101

and

103).

These can be accessed at the Board’s Web site

(www.ipcb.state.il.us).

The following

is a

summary ofsome ofthe most important points

in the

Act and the Board’s procedural rules.

It is provided for general informational purposes only and

does not

constitute legal advice or substitute for the provisions ofany statute, rule, or regulation:

Board Accepting Formal Complaint for Hearing; Motions

The Board will not accept this formal complaint for hearing if the Board finds that it is

either “duplicative” or “frivolous” within the meaning ofSection

3 1(d) ofthe Act (415 ILCS

5/31(d))

and Section

101.202 ofthe Board’s procedural rules

(35 Ill. Adm.

Code

101.202).

“Duplicative” means that

an identical or substantially similar case is already pending before the

Board or in court.

See 35

Ill.

Adm. Code 103.212(a) and item

10 of the formal complaint.

“Frivolous” means that the formal complaint seeks relief that the Board

does not have the

authority to

grant, or fails to state a cause ofaction upon which the Board can grant relief.

For

example, the Board has the authority to order a respondent to

stop polluting and pay a civil

penalty, to

implement pollution abatement measures, or to perform a cleanup or reimburse

cleanup costs.

The Board does not have the authority, however, to

award attorney fees to a

citizen complainant.

See 35

111.

Adm. Code 103.212(a) and items

5

and

9 ofthe formal

complaint.

If you believe that this formal complaint

is duplicative or frivolous, you may file a

motion with the Board, within 30 days after the date you were served with the complaint,

requesting that the Board not accept the complaint for hearing.

The motion must state the facts

supporting your beliefthat the complaint

is

duplicative or frivolous.

Memoranda, affidavits, and

any other relevant documents may accompany the motion.

Ifyou need more time than 30 days

to

file a motion

alleging that the complaint

is duplicative or frivolous, you must file a motion for

an extension oftime within 30 days after service ofthe complaint.

A motion for an

extension of

time must state why you need more time and the amount ofadditional time you need.

Timely

filing a motion alleging that the complaint is duplicative or frivolous will stay

tli’e 60-day period

for filing

an answer to the complaint.

See 35

Ill.

Adm. Code

103.204, 103.2i~4.