Citizen Complaint Illicit Discharge Reporting Form

Name *

First

Last

Contact Phone Number *

Date Submitted *

Time Discharge Discovered *

Date of Last Rain Event *

Estimated Quantity of rain in inches *

Location of Discharge (indicate nearby street intersections, addresses, and/or landmarks for reference): *

Where was discharge found? *

Was water flow observed? *

Was flow solid or pulsing? *

Was a photo taken? *

Odor *

Color *

Clarithy *

Was there an oily sheen? *

Was there garbage/sewage? *

Please add any additional information to assist in the investigation: *