ࡱ > k 8O bjbjZ Z 0^ 8cb8cb< { t n n n 8 N D s/ . 8 ` d . . . . . . . $ 0 W3 z . n $ " @ $ $ . F -/ y) y) y) $ ^ 8 . y) $ . y) y) + V B, `Au % , r. C/ 0 s/ , , 3 % 3 B, B, 3 n - T ! B" h y) " T " ! ! ! . . ( ! ! ! s/ $ $ $ $ 3 ! ! ! ! ! ! ! ! ! B : C O M P L A I N T F O R M To make a formal complaint against a licensed geoscientist or member of the public, and/or public or private entity, or to report possible violations of the Texas Geoscience Practice Act, please fill out this form in its entirety and submit to: Texas Board of Professional Geoscientists Attn: Compliance Department P.O. Box 13225 Austin, Texas 78711 Date: FORMTEXT F O R M T E X T C o m p l a i n t i s a g a i n s t : F O R M C H E C K B O X F i r m o r b u s i n e s s e n t i t y F O R M C H E C K B O X I n d i v i d u a l N a m e o f e n t i t y o r i n d i v i d u a l t h a t c o m p l a i n t i s b e i n g f i l e d a g a i n s t : F O R M T E X T F O R M T E X T F O R M T E X T I s t h i s e n t i t y o r i n d i v i d u a l l i c e n s e d ? F O R M C H E C K B O X Y e s F O R M C H E C K B O X N o F O R M C H E C K B O X U n s u r e P . G . # : F O R M T E X T F O R M T E X T ( i f a p p l i c a b l e ) F i r m R e g i s t r a t i o n # : F O R M T E X T F O R M T E X T ( i f a p p l i c a b l e ) C o m p l a i n t S u b m i t t e d b y : F O R M T E X T F O R M T E X T F O R M T E X T F O R M T E X T C o n t a c t I n f o r m a t i o n : P h o n e N u m b e r : F O R M T E X T F O R M T E X T F O R M T E X T F a x N u m b e r : F O R M T E X T F O R M T E X T F O R M T E X T A d d r e s s : F O R M C H E C K B O X H o m e F O R M C H E C K B O X B u s i n e s s F O R M T E X T F O R M T E X T F O R M T E X T F O R M T E X T F O R M T E X T E - m a i l A d d r e s s : F O R M T E X T F O R M T E X T F O R M T E X T F O R M T E X T F O R M T E X T 1 . I , F O R M T E X T F O R M T E X T F O R M T E X T , h e r e b y s u b m i t t h e f o l l o w i n g c o m p l a i n t f o r c o n s i d e r a t i o n o f d i s c i p l i n a r y a c t i o n b y t h e B o a r d i n a c c o r d a n c e w i t h 1002.154, 1002.203, 1002.204, and 1002.205 of the Texas Geoscience Practice Act. I am personally familiar with the facts and circumstances hereinafter presented and the impropriety of this matter suggests gross negligence, incompetence, or misconduct in the practice of professional geoscience. Because this matter affects the publics health, safety and welfare, I am filing this complaint against the above-cited person(s), entity or entities believing that their activities and/or conduct may be in violation of the Act or Board rules. I understand that the cited person(s), entity or entities will be furnished with a copy of this complaint for the purpose of response/rebuttal. 2. It is my contention that the cited person(s), entity or entities should be held accountable to the public through the authority of the Board for the following conduct, the details of which I am providing to show reasonable cause why the Board should investigate and act: 3. I also offer in evidence Exhibit A (through FORMTEXT ) . I h a v e a t t a c h e d h e r e t o a l i s t o f t h e s e e x h i b i t s f o r t h e B o a r d s c o n s i d e r a t i o n i n e v a l u a t i n g t h i s c o m p l a i n t . T h e e x h i b i t s t h e m s e l v e s w i l l b e s u b m i t t e d t o t h e B o a r d i n t h e f o l l o w i n g m a n n e r : ( P l e a s e c h e c k t h e a p p r o p r i a t e b o x ) F O R M C H E C K B O X Scanned and sent electronically to HYPERLINK "mailto:compliance@tbpg.state.tx.us" compliance@tbpg.state.tx.us FORMCHECKBOX Faxed to 512-936-4409 ATTN: Compliance Department FORMCHECKBOX Mailed separately from this complaint FORMCHECKBOX Enclosed with this complaint 4. I have also included a list containing the names, business addresses and telephone numbers and e-mail addresses (if available) of all other persons who have direct interest or possess pertinent information in this matter, a n d w h o s e t e s t i m o n y s h o u l d b e c o n s i d e r e d b y t h e B o a r d i n d e t e r m i n i n g i t s f i n a l d i s p o s i t i o n o f t h i s m a t t e r . 5 . 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