Pollution and Water Waste Incident Report

Pollution and Water Waste Incident Report
Thank you for filing a pollution incident report. Please fill out as much of the form as you can, and we'll make sure it gets to the right organization or government/state institution.
What type of problem did you see?*

Urgent/EmergencyOngoingOther
If other, please describe
Which type of pollution is this?*

Over WateringOilHazardous WasteLittering/DumpingPet WasteSoap/DetergentUnidentified substance in runoff (e.g. brightly colored runoff)SewageOther
If other please specify
Please describe pollution or water waste*
Where did you see this? (please include address or landmarks)*
Date of incident*

MonthDayYear
Jurisdiction
Does it flow to a creek or storm drain?

YesNoI can't tell
Suspected Source: Please include Name, Address, Phone Number and any other information you have.
Have you reported this?

Municipal Hotline911 for emergency use only (such as dumping of oil down a storm drain)I have not reported thisOther
If you reported this, please type the details of your conversation here(as much detail as possible):
What evidence do you have?

PhotoVideoOtherNone
If you have photos or videos, please upload them here

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Photo or video 2

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Photo or video 3

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Your Contact Information

We ask for your contact information so we can call you back in case we have follow up questions and/or to let you know the outcome of your report. However, all reports to our online system are submitted under the name of San Diego Coastkeeper. Your personal information is not released without your expressed permission.
Full Name

First NameLast Name
E-mail
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Do you wish to remain anonymous?
Enter the message as it's shown*
Should be Empty: