Illicit Discharge Reporting Form

Illicit Discharge Reporting Form

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Steps

1. 1. Step One (current) This section is complete This section is incomplete
2. 2. Location of Your Issue This section is complete This section is incomplete

Step One

2. Please use this form if you see dumping in or near a storm drain, stream or ditch in the Town of Lisbon. If reporting anonymously, please provide as much information as you can in order to allow us to follow up on your complaint.

3. Contact Email (Optional)

4. Continue

Location of Your Issue

2. Address*

3. City*

4. State*

5. Zip Code*

6. Location Type*

   1. Commercial/Business
   2. Industrial Residential
   3. Unsure/Other

7. If there was a business involved, please provide the name of the business

8. Date(s) that you saw the discharge*

9. Time(s) that you saw the discharge*

10. What do you think the discharge is?*

    (paint spill, oil spill, sewer leak, grease, soap, sediment, etc.)

11. Can we contact you for more information?*

    1. Yes
    2. No

    If 'Yes', please be sure to provide your contact information above.

Leave This Blank:

20. 1. Receive an email copy of this form.

21. Email address

    This field is not part of the form submission.

22. Submit | Go Back

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