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2. Please fill out the form as completely as possible. It is the policy of the City of Centralia to keep the identification of any reporting parties strictly confidential, pursuant to the privilege within the Washington Public Information Act. The 24-hour telephone number to report any illegal dumping activity is 360-330-2747.

4. First Name*
6. Last Name*
8. Address Line 1*
10. Address Line 2
12. City*
14. State*
16. Zip Code*
18. Daytime Phone*
20. Evening Phone*
22. Email Address
24. Location of Illegal Dumping Violation*

    Enter exact or close physical address. Include the specific location of the violation such as an alley, sidewalk, or planter

26. Description of Illegal Dumping*

    Please describe the type of material.

28. Comments

    Please include any comments or further descriptions of materials to help our inspectors.

Leave This Blank:


30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit

* indicates a required field