2. 

3. Report an Illicit Discharge to the SMS4

   This form is for reporting illicit discharge(s) into the small municipal separate storm sewer systems (SMS4).  Here is a link to help identify SMS4 areas:  SMS4 Maps

   Items marked with an asterisk (*) are mandatory fields.

5. Reporting Party's Name*
6. Reporting Party's Physical or Mailing Address
8. Reporting Party's Phone Number*
9. Reporting Party's Email Address*
11. Date Discharge was Observed*
    Date Discharge was Observed
12. Material Released*
    -- Select One --AntifreezeConcreteChemical(s)Cooking oil/greaseFertilizerMotor OilPaintPet WastePetroleum FuelsSedimentSewageTrashOtherUnknown
13. Media Impacted*
    -- Select One --PondRoad/Parking Lot/DrivewaySoilOpen Channel/DitchStorm DrainStreamOther
15. Location of Discharge (Lat/Long or Address)*
17. Discharge City*
18. Discharge State*
19. Discharge Zip Code*
21. Description of Incident*
23. Attachments (Optional) i.e. Images
Leave This Blank:


25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

* indicates a required field