select
 
               
Submit a complaint  Click Here
* In what State did the spill or release occur?  
I would like to report a spill or release on behalf of the party responsible for the spill or release
I would like to report a spill or release of which I am aware but was caused by others
I wish to remain anonymous
You may contact me for additional information
Did you personally witness the spill or release?
Enter the text you see in the image to the right.
 


   
   
*  indicates a required field  
   
* What is your name?  
    Your Title?
    * Your Phone Number?   
    Your Email Address?     
     Do you wish to be informed of the results of DEQ's investigation into the incident?  

Company Contact Information

 
* What is your company's name?  

Company Address

 
    * Street Address 1   
    Street Address 2 
    * City   
    * State 
select
 
    * Zip Code   
    * Company Phone   
    Company Web Site 
    Company Email Address   
   
*  indicates a required field  
               
   
* What is your name?  
   
Your Contact Information  
    Street Address 1 
    Street Address 2 
    City 
    State 
select
    Zip Code 
   
Phone and Email  
    Home Phone 
    Cell Phone 
    Email Address     
    Do you wish to be informed of the results of DEQ's investigation into the incident?
   
*  indicates a required field  
               
When and Where Did the Incident Happen?  
    
Please provide as much information as is known:  
   
* What was the date and time the incident occurred?
  
* At least ONE of Address, Lat/Long, PLSS or Additional Location Information is required.
   
Incident Address:  
Street Address  
City
In what Wyoming county did the spill or release occur?
select
      
At what latitude and longitude?
(Dec.Degs e.g.: Lat: 42.8 Long: -105.9)
   
Latitude:
        Longitude:  
    
In what Section, Township, and Range (PLSS):  
        Section  
        Township
        Range
   
Quarter-Quarter Section:  
Quarter:
select
 
Quarter Quarter:
select
   
Additional Location Information:  
What additional location information can you provide that would help us locate the site of the incident?

For example, highway mileposts, nearby signs, buildings or other landmarks.
*  indicates a required field
               
What was spilled or released?  
    
* Was the source of the spill in transit (truck, train, boat, etc) or fixed (building, structure, pipe, etc)?
select
  
    
If in transit, what kind of vehicle was the source of the spill?
select
   
    
If the source was fixed, what kind of facility was the source of the spill?
select
   
    
If the facility source was "Other", please describe the facility?    
    
If the source was a LAUST-FAC, what is the Facility ID?    
    
* What type of event was occurring at the time of the spill or release?
select
  
    
If the initiating event was "Other", please describe the event.    
    
* What substance was spilled or released?
select
  
    
If the substance spilled or released was "Other", please descibe the substance.    
    
What quantity was spilled or released?
select
 
If units are "Other" specify the units    
* What media was affected?
select
  
If media affected is "Other", specify the media    
    
Did the spill reach or have potential to reach water? If so, what body of water was affected?
    
What additional information can you provide that would help us understand the nature of the incident? For example, accident description, nearby related events, weather conditions, etc.
    
*  indicates a required field  
               

 

Thank you for reporting the spill or release.

Incident ID:

Note the Incident ID for future reference. You may print this screen as your record of this incident report.

If requested, you will be notified.

Contact the Emergency Request Coordinator at (307)777-5885 or email joe.hunter@wyo.gov for further information.



To print your Incident Details Click Here

 
Welcome to the WDEQ Internet Portal!
Privacy Policy  |  Copyright Statement
 | Copyright © 2015 State of Wyoming. All rights reserved.