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2. When the Illicit Discharge Was Detected
   When the Illicit Discharge Was Detected

   When the Illicit Discharge Was Detected

   Provide the date and approximate time that the illicit discharge was detected.

3. Location of Illicit Discharge

   Describe where the illicit discharge is located.

5. Description

   Provide a description of the detection with any information that would aid Town staff in addressing and correcting the illicit discharge.

7. Provide Images, If Available
9. Do You Wish To Be Contacted Regarding This Report?

   1. Yes

   If so, please check the box and provide your contact information. 

   If you wish to remain anonymous, please leave these fields blank.

11. Name
12. Email Address
14. Phone Number
Leave This Blank:


16. 1. Receive an email copy of this form.
17. Email address

    This field is not part of the form submission.

18. Submit

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