Johnson County Stormwater - Report Discharge

Report Stormwater Pollution Form

Tracking Information
Report Date:	8/7/2008

Reporter Information

What time did you discover the pollution?

What day did you discover the pollution?

Select Yes if you would like to be contacted with the result of this investigation.
If Yes is selected, please complete the Contact Information section when it appears on your screen.

Yes

First Name:

Last Name:

Address:

City:

State:

Zip Code:

Phone Number

Email Address

Incident Location (complete one or more below)

City:

Closest Intersection:

ex: "Blue River Highway" or "151st and Nall"

Closest Street Address:


Primary Location Description		Secondary Location Description


Description of Location:


Description of problem in or near a stream
Odor	None	Sewage	Rancid/Sour
	Sulfide(Rotten eggs, natural gas)		Petroleum/Gas
	Other

Appearance	Normal	Oil Sheen	Cloudy
Appearance	Suds	Other

Floatables	None	Algae	Sewage (toilet paper, etc)
Floatables	Dead Fish	Other

Description of problem on land away from a stream
Dumping	Oil/solvents/chemicals	Sewage
Wash Water, Suds, etc	Other

Narrative Description of Pollution Found


Suspected Violator

JOHNSON COUNTY STORMWATER MANAGEMENT PROGRAM
1800 W. 56 Highway
Olathe, KS 66061
Phone: (913) 715-8333
Fax: (913) 715-2453