WAIVER SUBMITTED SUCCESSFULLY!Please fill out the form below and UPLOAD your test results.↓ SUBMISSION FORM All questions below relate to the home impacted by the Eaton Fire and where testing was done. Name * First Name Last Name Were the home's test samples taken before or after remediation or general cleaning? * Before After How close is the nearest burned structure to the home? * Under 100 Feet 100 - 750 Feet Over 750 Feet Did the home sustain damage from the fire? * Check all that apply. Some fire damage to main house. Doors or windows open or broken, allowing soot and ash to enter. Fire damage to fence or detached structures. Damage to yard or trees. No direct damage to my lot. Please select your home insurance company. * Choose 'uninsured' if you have none or 'unlisted' if not on this list. uninsured AAA AIG Allstate American Modern Amica Mutual California FAIR Plan Chubb Limited CSE Farmers The Hartford Liberty Mutual Mercury MetLife Nationwide Progressive Safeco State Farm Travelers USAA Western Mutual not listed What is your relationship to this home? * Rent Own I have the authority to share these test results. Thank you! We have received your test results and hope to have them represented in our mapping project soon. If you have any questions or comments please contact us here. Upload Your Test Results
