State of California
Department of Food and Agriculture
air/water complaint form
1 (800) 356-7057
41-016a/w (Rev. 05/12)
California law requires that station operators provide free air and water to customers who purchase gasoline or diesel fuel.

After requesting free air and water from the attendant on duty, was the equipment activated or were you provided a token? If not, you were refused free air and water service. Please complete and submit online at www.cdfa.ca.gov/dms, or mail to: Division of Measurement Standards, 6790 Florin Perkins Road, Suite 100, Sacramento, CA 95828.

Please enter your information:
 
NAME    
 
STREET   
                
CITY    ZIP   
 
PHONE: 

EMAIL: 
 
Enter the business information:
 
STATION NAME   
TELEPHONE    
 
ADDRESS   
 
CITY    ZIP   
COUNTY  
   
DATE  		TIME OF VIOLATION   
DESCRIBE YOUR COMPLAINT USING CHECK BOXES AND ADDING REMARKS BELOW
Toll free number not posted
Air not available
Air not working
Air pressure gauge not available
Air not free with fuel purchase
Water not available
Water not working
Water not free with fuel purchase

CUSTOMER COMPLAINT:

 
IMPORTANT: Please read before submitting your complaint.
  • Without a fuel purchase there is no legal requirement that air and water be provided by the station.
  • Members-Only Discount Warehouse Retailers and Cardlock Facilities are not subject to this law.