Illicit Discharge

2. 

3. City of Inverness

   Illicit Discharge Observation Report

5. Today's Date*
   Today's Date
6. Date and Time Observed*
   Date and Time Observed

   Date and Time Observed
8. First Name
9. Last Name
11. Phone Number
12. E-mail

    If we may contact you by email, please provide.

14. Location*

    Location that the concerned was observed at.

16. Description of Observation*

    Please describe what was observed at the location of concern.

18. Is it still occuring?*

    1. Yes
    2. No
    3. Unsure
19. Is there an odor?*

    1. Yes
    2. No
    3. Unsure
21. Is the source of the condition evident?*

    1. Yes
    2. No
22. Current flow conditions?*

    1. None/Low
    2. Medium
    3. High
    4. Flooded
26. Picture Upload

    If you have a picture of the condition, please attached it here.

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