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2. To report suspected pollution discharge, please complete this form. You can also report such discharge by phone between the hours of 8 a.m. and 4 p.m. at 850-981-7135 or 850-981-7090
   
   For suspected hazardous spills call the Local Fire Department.
4. Suspected Pollution Discharge Address
5. Today's Date
   Today's Date
7. Pollution Discharge Type (if Known)
8. Date & Time (if Known)
   Date & Time (if Known)

   Date & Time (if Known)
10. Contact Name*
11. Phone Number*
12. Email Address
14. Additional Information
16. Attach Photo here (Optional)
Leave This Blank:


18. 1. Receive an email copy of this form.
19. Email address

    This field is not part of the form submission.

20. Submit

* indicates a required field