Citizen Complaint Illicit Discharge Reporting Form
Name
*
First Name
Last Name
Contact Phone #
*
-
Area Code
Phone Number
Today's Date
*
-
Month
-
Day
Year
Date
Time Discharge Discovered:
*
Date of Last Rain Event
*
-
Month
-
Day
Year
Date
Estimated Quantity of Rain (inches)
*
Location of discharge (indicate nearby street intersections, addresses, and/or landmarks for reference):
*
Where was the discharge found:
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Open ditch
Stream
Pipe outfall
Other
Was water flow observed?
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No
Yes
Was flow solid or pulsing?
*
Solid
Pulsing
Was a photo taken?
*
No
Yes (please attach below)
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of
Odor:
*
None
Musty
Sewage
Rotten eggs
Sour milk
Other
Color:
*
Clear
Red
Yellow
Brown
Green
Grey
Other
Clairity:
*
Clear
Cloudy
Opaque
Was there an oily sheen?
*
Please Select
Yes
No
Was there garbage/sewage?
*
Please Select
Yes
No
Other:
*
Additional information to assist in the investigation:
*
Submit
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