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!
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
:
Where did you observe the discharge? *
Required
Location of Event (indicate nearby street intersection, address, and/or landmarks for reference) *
Your answer
Flow Description
Was water flowing at the time? *
Was the flow consistent or pulsing? *
Was there an odor? *
Was there a color? *
Was the discharge clear or cloudy? *
Was there an oily sheen on the surface of the flow? *
Was there sewage present in the flow? *
Additional Information
Please provide any additional details here.
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy