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Spill Reporting

2. City of Anacortes Online Spill Report Form
   Please fill this form out as completely as possible. You have the option to submit anonymously.

   Please fill this form out as completely as possible. You have the option to submit anonymously.

4. Date Discovered
   Date Discovered

   Date Discovered

5. Weather Conditions
   -- Select One --ClearCloudyDrizzleRainFreezing

7. Pollutant Location (check all that apply)

   1. Storm Drain (Catch Basin)
   2. In/On Street
   3. Puget Sound

   1. Ditch
   2. Swale
   3. Pond

9. Address (if known)

11. Location Description

13. Description of Incident

15. Substance (if known)
    -- Select One --Automotive Fluids (oil, gas, antifreeze)PaintGarbageSewageDirt/Erosion MaterialConcreteConstruction MaterialSoapy WaterChemical SpillDon't KnowOther (include in Additional Information section below)

16. Files

    Photos or documents related to this incident

18. Additional Information

20. Contact Information (Optional)

22. Name

23. Contact Preference

    1. Please contact me regarding this incident.

25. Email

26. Phone

27. Privacy Preference

    1. I request that information revealing my identity not be disclosed.

Leave This Blank:


29. 1. Receive an email copy of this form.
30. Email address

    This field is not part of the form submission.

31. Submit

* indicates a required field