NCS000431_Blank Inspection Report_20190926

Name of City Staff/Inspector:
City Department:
Phone Number:
Date:
ILLICIT DISCHARGE INSPECTION FORM
Email
Days since last rainfall:
Stream Name: Tributary: Date: _
Stream Segment: (from) (to)
Location of Possible Illicit Discharge (Indicate nearby street intersections, addresses, and/or landmarks for reference):_
Where was the discharge found?
Open Ditch
Stream Pipe Outfall Other:
Was water flow observed?
Yes
No
Was a picture taken?
Yes
No
Was there an oily sheen?
Yes
No
Could you see garbage?
Yes
No
Did it look like sewage?
Yes
No
Odor: None Musty
Sewage
Rotten Eggs Sour Milk Other:
Color: Clear Red
Green
Brown Grey Other:
Clarity: Clear Cloudy
Opaque
Other observations:
Additional information to assist in the investigation: