Initial IDDE Response Form

Contact Name *

Contact's Phone Number *

Incident Date:

Incident Time:

Incident Location: *

Nearest Landmark/Building: *

Spot of Illicit Discharge (Check all that apply)

Outfall

Near Storm Drain

In-Stream Flow

Along Banks

Upland Area (not near stream or drain)

Narrative Description of Location *

Appearance (check all that apply) *

Normal

Oil (rainbow) sheen

Cloudy

Soapy/Sudsy

Colored

Other

If appearance is other please describe:

Odor (check all the apply) *

None

Sewage

Rancid/Sour

Petroleum/Gas

Sulfide (rotten eggs), natural gas

Other

If odor is other please describe:

Floatables (check all that apply) *

None

Sewage (toilet paper, etc.)

Alge

Dead Fish

Other

If floatables is other please describe:

Other Comments

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