2. Please use this form to report any of the following conditions that you see in a ditch, storm drain system or wetland area within the City of Marysville: vehicle fluids, paint, chemicals, soap/washwater, concrete or mortar, pesticides or fertilizer, excessive dirt or gravel, fats, oils, grease, animal waste, sewage spills, etc. You can also report information or request a water quality complaint investigation by calling the City's Water Spill Hotline at (360) 363-8100. If this is a HAZARDOUS MATERIALS SPILL, please call 911 immediately.
4. Confidentiality*

   Under Chapter 42.56 RCW, the Public Records Act, a Complaint Form is a public record subject to disclosure. You, as a complainant, may request that you identity not be disclosed to the public. If you request that the City not disclose your identity, the City will attempt to honor your preference, but makes no assurances that your identity will not be made public. Additionally, if the complaint results in a case being filed in court, you will most likely be named as a witness and your identity will therefore be disclosed.

   1. Upon a public records request, my identifying information may be disclosed
   2. I request that the City attempt to keep my identifying information confidential
6. First Name*
7. Last Name*
9. Address1*
11. Address2
13. City*
14. State*
15. Zip*
17. Home Phone*
18. Work Phone
19. Email
23. Responsible Party (if known)
25. First Name
26. Last Name
28. Company Name
29. Phone Number
31. Address1
33. Location Information: Where did the spill or discharge happen?
35. Address
37. City
38. Parcel Number (if known)
40. Additional Location Information
    Please provide as specifically as possible where the condition is located.
44. Complainant Information

    Please indicate that nature of non-emergency spill or discharge.

    1. Algae
    2. Bacteria, bloom
    3. Bacteria, rust
    4. Carcass
    5. Chemical, unknown
    6. Drainage
    7. Erosion, construction
    8. Erosion, natural
    9. Fat, oils and grease
    10. Fertilizer, herb, pest
    11. Fill
    12. Flood

    1. Foam
    2. Gasoline
    3. Hazardous waste, business
    4. Hazardous waste, house
    5. Manure
    6. No site
    7. None
    8. Other
    9. Paint
    10. Petroleum, oil
    11. Petroleum, other

    1. Pool
    2. Process wastewater
    3. Requesting information
    4. Septic Failure
    5. Sewage
    6. Soap or car wash
    7. Solid waste
    8. Street/lot waste
    9. Vegetation
    10. Water, ground
    11. Water, potable
46. Date/Time of Spill
    Date/Time of Spill

    Date/Time of Spill
48. Additional spill detail
Leave This Blank:


50. 1. Receive an email copy of this form.
51. Email address

    This field is not part of the form submission.

52. Submit

* indicates a required field