Report Stormwater Pollution Form

Report Stormwater Pollution Form
If you have been witness to, or suspect a stormwater pollution incident in the City of Greensboro, please use this form to describe it and the location.

Anyone who submits a form should be aware that in accordance with the North Carolina Public Records law, found in North Carolina General Statutes Chapter 132, their e-mail address is considered public record.
Contact Person*

First NameLast Name
Address of pollution*
Date and time you saw the pollution*

MonthDayYear
Date
Hour MinutesAM/PM Option
How did the substance enter the stormwater?

CreekStorm Drain or Sewer
Choose where the substance entered:*
What was the substance?*

Fuel/OilSediment from construction sitesPaintGreaseSewageUnknownOther
What was the color of the substance?*

BrownRedWhiteClearRed/OrangeGreenOther
Additional Description*

CloudyBubblesOily SheenOdorAlgae
Describe the cloudiness.
Describe the bubbles.
Describe the oily sheen.
Describe the odor.
Describe the algae.
Do you know the offending party?*

YesNo
Please provide any contact information for this party, this will be helpful during the investigation.
Do you see dead fish?*

YesNo
Upload photo (optional)

Cancelof
If we need additional information, how should we contact you?*

Cell PhoneEmail
Cell phone number*
Please enter a valid phone number.
Email*
example@example.com
Do you wish to be contacted in regards to this complaint?

YesNo
Anything else we should know?
Should be Empty: