Clean Water Program

Your Name*
Last: First: MI

Your Home Telephone Number* (555-555-5555):

Your Alternate Phone (Cell/Work)*:

Email*:

What type of incident do you wish to report? Check all that apply:

Failing septic systems
Livestock in stream
Manure management
Dumping Down a Storm Drain
Suspicious Discharge from Pipe into a Stream
Water in Stream is an Unusual Color
Water in Stream Smells Strange
Suspicious Suds or other Substance Floating on Water
Fish or other Aquatic Creatures appear to have Died
Other (explain)

Where did the incident take place?

Address Street / Number

Location of Incident (Cross streets, body of water impacted, please be as specific as possible):

Date of Incident (mm/dd/yyyy):
Time of Observation (hh:mm am/pm):

Please add any details that might help a responder locate the site and know what to look for to take a sample.

If you have photos or other documentation they can be emailed to: rickh@co.skagit.wa.us

Please specify in more detail how you heard about this web site and this form. This will help us reach the public more effectively.

Check here if you would like a return call on the disposition of the incident.