AHTD STORM WATER COMPLAINT FORM

Please fill in the following information about your complaint

*asterisk indicates information that is required, all others are optional

Date of Discharge Nearest City or Town Highway Number

*Specific description of Violation

*Address where violation occurred or clear directions to violation location/driving directions.  Please be as exact as possible.

Name, address, and telephone number  of the individual, company, 

business, or government entity responsible for the violation, if known.

Information about You:

(Note: Giving us your name, address, phone number and/or e-mail address is optional -- you do not need to provide them in order to send us your questions, comments or complaints.  However, if you do not, we will not be able to provide you with any follow-up information. 

Your name

Your telephone number, including area code. 

Your e-mail address 

Note:  Click "Submit Now" only ONCE.

THANK YOU!