Form Center

Report Water Waste

2. Date of Observation*
3. Time of Observation (am or pm)*
5. Observed Frequency of Waste*

   1. Sunday
   2. Monday
   3. Tuesday

   1. Wednesday
   2. Thursday

   1. Friday
   2. Saturday
7. Address / Location of Observation*
9. City*
10. State*
11. Zip Code*
13. Type of Location*
15. Possible Cause of Waste*
17. Attach Photo
    Including a detailed photo of the violation being reported is the best way to ensure that the appropriate customer can be contacted regarding the issue. Reports that do not include a photo of the violation may not result in customer notification.
19. Comments
21. Reporter's Email*
    To be used if RCWD has questions regarding your report.
Leave This Blank:


23. 1. Receive an email copy of this form.
24. Email address

    This field is not part of the form submission.

25. Submit Submit and Print

* indicates a required field