MODULO SEGNALAZIONE Igiene Ambientale

CITTÀ
di
VENTIMIGLIA
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MODULO SEGNALAZIONI E ISTANZE – UFFICIO IGIENE AMBIENTALE
Il sottoscritto/a ________________________________________________________
residente in ___________________________________________________________
Tel.: ____________ Cell.: ____________ Mail: ______________________________
In merito alla raccolta differenziata “porta a porta”, SEGNALA / RICHIEDE :
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Ventimiglia, lì _______________
Firma ______________________________
PARTE RISERVATA ALL’UFFICIO
VERIFICA ESEGUITA DA _____________________________________________
IL GIORNO _________________________ ALLE ORE ____________________
ESITO________________________________________________________________
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