Illicit Discharge Reporting Form
Have you witnessed an illicit discharge? Please fill out the short survey below to inform us of the event. We appreciate your efforts in keeping our water clean!
* Required
Part 1: Contact Information
Name
*
Your answer
Contact Phone Number
*
Your answer
Contact Email Address (Optional)
Your answer
Discharge Event Details
Date Event Occurred
*
MM
/
DD
/
YYYY
Time Event Occurred
*
Time
:
AM
PM
Where did you observe the discharge?
*
Stream
Open ditch
Storm drain pipe
Storm drain
Other:
Required
Location of Event (indicate nearby street intersection, address, and/or landmarks for reference)
*
Your answer
Flow Description
Was water flowing at the time?
*
Choose
Yes
No
Was the flow consistent or pulsing?
*
Choose
Consistent
Pulsing
N/A, no flow was observed
Was there an odor?
*
Sewage
Rotten eggs / Sulfur
Sour milk
Musty
No odor
N/A, no flow was observed
Other:
Was there a color?
*
Red
Yellow
Brown
Green
Grey
No, discharge was clear
N/A, no flow was observed
Other:
Was the discharge clear or cloudy?
*
Choose
Opaque
Somewhat cloudy
Clear
N/A, no flow was observed
Was there an oily sheen on the surface of the flow?
*
Choose
Yes
No
N/A, no flow was observed
Was there sewage present in the flow?
*
Choose
Yes
No
N/A, no flow was observed
Additional Information
Please provide any additional details here.
Your answer
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