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City of Clarkston - Georgia - where possibilities grow

 

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Water Quality 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?(*)



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If other please specify

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Which type of pollution is this?(*)







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If other please specify

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Please Describe

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Where did you see this? (Please include address or landmarks)

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Date of incident

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Does it flow to a creek or strom drain?



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Suspected Source: Please include Name, Address, Phone Number and any other information you have.

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Have you reported this?




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If you reported this, please type the details of you conversation here (as much detail as possible)

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What evidence do you have




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If other please specify

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Please provide any further details here

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If you have photographs or video have the problem, please email them to us.



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 Iet you know the outcome of your report. However, your personal inform ation is nat reieased without your expressed permission


First Name(*)

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Last Name(*)

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Email(*)

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Phone

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Street Address

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City(*)

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State(*)

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Zip Code(*)

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Do you want to remain anonymous?(*)


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Password(*)

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Confirm Password(*)

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