Illicit Discharge Hotline Incident Tracking Sheet
Responder Information
2. Call taken by: Web	4. Call date:
3. Call time:	5. Precipitation (inches) in past 24-48 hrs:
Reporter Information
6. Incident time:	7. Incident date:
Suspected Violator (name, personal or vehicle description, license plate #, etc.):
Caller contact information (optional):

Incident Location (complete one or more below)
10a. Latitude and longitude:
10b. Stream address or outfall #:
10c. Closest street address:
10d. Nearby landmark:
Primary Location Description	Secondary Location Description
Stream corridor	Outfall	In-stream flow	Along banks
Upland area	Near storm drain	Near other water source (storm water pond, wetland, etc):
11. Narrative description of location:

Upland Problem Indicator Description
12. Dumping	13. Oil/solvents/chemicals	14. Sewage
15. Wash water, suds, etc.	16. Other:

Stream Corridor Problem Indicator Description
17. Odor	None	Sewage	Rancid/Sour	Petroleum (gas)
	Sulfide (rotton eggs); natural gas		Other: Describe in "Narrative" section
18. Appearance	Normal	Oil Sheen	Cloudy	Suds
	Other: Describe in "Narrative" section
19. Floatables	None	Sewage (toilet paper, etc.)	Algae	Dead fish
	Other: Describe in "Narrative" section
20. Narrative description of problem indicators: