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Report Pollution Incident

Please add the details of the incident below.

Fields marked with * are mandatory.

Incident details

Brief description (max. 60 characters)*

Type of pollution*

Date of incident*

Time of incident (HH.MM format e.g. 20.15)

Further details

Your contact details

Please enter your details so we can contact you. Your details will not be used for any other purpose.

Title

Forename*

Surname*

House or building name

House or flat number

Street

Town

Postcode

Email address

Phone number

Mobile number

Incident location

Incident location*

House or building name

House or flat number

Street

Town

Postcode

Documents

You may upload up to 5 documents related to this request. Click on the Choose File button to select the file(s) to be uploaded.
Total file size must not exceed 5MB.
File types accepted are .jpg, .png, .bmp, .tif, .gif, .pdf, .zip, .mp4

Documents