Complaint Reporting form/phone number Below:
TOWN OF HORIZON CITY◦
PUBLIC WORKS DEPARTMENT
STORM WATER MANAGEMENT PROGRAM MS4 ▪ COMPLAINT REPORTING
COMPLAINT REPORTING FORM
Discharge into Storm Drains, ponds, streets, culverts, curbs, etc.
The wastewater and sewage that drains from inside household residence(s) and commercials is treated and cleaned. But the storm drains, gutters, pond outlets in the streets flow directly to lakes, rivers, etc., untreated. That is why it is important that it should not be allowed to dump waste of any kind onto street surfaces, drainage pipes and ditches, or into storm drains – they are only for rainwater/runoff. If you see anyone dumping anything onto street surface, into storm drains, or into any other device built to contain rainfall or water runoff, please report violation(s) by calling 915-852-1046 ext. 402 or Storm water hotline at 1-877-433-5697, or by using the form below and submitting it to the Town of Horizon City, 14999 Darrington Rd., Storm Water Management personnel:
You must leave at least one form of contact information in order to be updated on the status of the complaint involved. Contact information is also necessary so that we may receive additional information concerning the complaint.
Allpersonal information is kept confidential!
Your Name: ______________________________________
Your email address: ______________________________________
Your Phone #: ______________________________________
Address where illegal Discharge Exists:
FOR OFFICIAL USE ONLY
Street Address: ______________________________________
Nearest Cross Street: ______________________________________
Type of Illegal Discharges: __Paint Products __Chemicals __Pesticides
__Dirt/Trash __Other __Oil Products
Date and Time: Date:__________________ Time:___________AM/PM
Was a commercial vehicle involved? YES NO
If so, what was the company name or license plat number on the vehicle?
Company Name _____________________________________
License Plate (State/Number) ___________________________________
Was a commercial facility involved? YES NO
Please describe additional information concerning your complaint below:
Person receiving Complaint Report Date:_____________________
Signed:___________________________________ Printed Name:_____________________________
COMPLAINT REPORT ACKNOWLEDGE RECEIPT