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    Use This Form to Report Water Pollution to Environmental Management

    If you are reporting an emergency situation that could result in imminent and substantial danger to the health and safety of persons, please disregard this form and call 911.

    Please fill out this form as completely as possible.

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    Person Reporting the Incident
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    First Name:
    Last Name:
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    Phone Number:
    Email:
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    Incident Location
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    Date:
    Time:
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    Exact information about the location of the offense is very important. If the street address is not known, describe the location as accurately as possible. Example: "Lot to the north of 5600 S. 10th Street" or "Vacant lot on the south east corner of 19th and Farnam Streets"
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    Location:
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    Description of Incident
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    Incident Information
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    Name (person or company):
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    Address:
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    City:
    State:
    ZIP:
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    Please provide a description of the violator (gender, age, race, hair color, height, etc.)
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    Was a vehicle observed during the incident?
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    State of vehicle's registration:
    License Plate Number:
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    Make:
    Model:
    Color:
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    Any Additional Vehicle Information:
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    Type what you see in box below.

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