Form Center

2. Resource Receiving Illicit Discharge*

   1. River
   2. Stream
   3. Storm Sewer
3. Date & Time of Occurrance
   Date & Time of Occurrance

   Date & Time of Occurrance
5. Address of Spill or Dumping
7. Other Location Details
9. Type of Illicit Discharge

   1. Sewage or Septic Flow
   2. Wastewater (from commercial car washing, fleet washing, laundry from homes or commercial laundry)
   3. Chemical or Liquid Waste (automotive fluids, paints, etc.)
   4. Bulk Dry Powder (fertilizer, etc.)
11. Specific Material(s) Illicitly Discharged, If Known
13. Approximate Quantity Discharged, If Known
15. Pictures
17. Other Important Information
21. Contact Information
23. First Name*
24. Last Name*
26. Phone Number*
27. Email Address*
Leave This Blank:


28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit

* indicates a required field