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ILLICIT DISCHARGE REPORTING FORM
Name:
Date:
Contact Phone Number:
Time Discharge Discovered:
Date of Last Rain Event:
Estimated Quantity of Rain (inches):
Location of Discharge (indicated nearby street intersections, addresses, and/or landmarks for reference):
Where was the discharge found?
Was water flow observed?
If Yes, flow was:
Was a photo taken?
Odor:
Color:
Clarity:
Additional Conditions:
Comments:
Open Ditch
Stream
Pipe Outfall
Other:
No
Yes
Solid
Pulsing
No
Yes (Please attach to bottom of form in comments section)
None
Musty
Sewage
Rotten Eggs
Sour Milk
Other:
Clear
Red
Yellow
Brown
Green
Grey
Other:
Clear
Cloudy
Opaque
Oily Sheen
Garbage
Sewage
Other: