Illicit Discharge Form

Print

Font Size: + -

Please correct the fields below:

Please correct the field(s) marked in red below:

1

Provide the address or general location of where the illicit discharge is occurring:

2

Describe the situation:

3

Would you like to be contacted regarding your comments?

Yes

No

4

If so, you may fill out the form below and someone will contact you.

First Name

Last Name

Email Address

Phone Number

Any additional comments

To receive a copy of your submission, please fill out your email address below and submit.
Email Address

City of Marion, IA