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You may remain anonymous if you wish, but providing contact info will help us follow up on your report.
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Name (optional):
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| Today's Date: |
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Email (optional):
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| Phone (optional): |
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| Water Body Affected: |
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| Please provide a detailed description of the location including roadways, landmarks, etc.: |
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| Pollution (please list the date, time, and duration of the problem, weather conditions, and description of what you observed): |
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| Time, date and duration |
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| Weather Conditions |
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| Suspected Cause/Polluter |
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| Please describe what you observed (i.e. type of pollution, sights, smells, etc.) |
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| Have you seen this before? |
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| If so, when or for how long? |
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| Do you have pictures? |
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| If so, who and when? |
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| Have you notified any regulatory agencies? |
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| If so, who and when? |
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| Security Code: |
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