{"id":5474,"date":"2020-02-28T15:36:21","date_gmt":"2020-02-28T15:36:21","guid":{"rendered":"https:\/\/pittstontownship.org\/?page_id=5474"},"modified":"2020-03-12T09:20:19","modified_gmt":"2020-03-12T14:20:19","slug":"illicit-discharge-reporting-form","status":"publish","type":"page","link":"https:\/\/pittstontownship.org\/?page_id=5474","title":{"rendered":"Illicit Discharge Reporting Form"},"content":{"rendered":"<form action=\"\" method=\"POST\" enctype=\"multipart\/form-data\">\n<div class=\"form-inline\">\n<div class=\"fields\">\n                <label for=\"name\">Name:<\/label><br \/>\n                <input type=\"name\" id=\"name\" placeholder=\"\" name=\"name\">\n            <\/div>\n<div class=\"fields\">\n                <label for=\"phone\">Contact Phone Number:<\/label><br \/>\n                <input type=\"tel\" id=\"phone\" placeholder=\"\" name=\"phone\">\n            <\/div>\n<\/p><\/div>\n<div class=\"form-inline\">\n<div class=\"fields\">\n                <label for=\"date\">Date:<\/label><br \/>\n                <input type=\"date\" id=\"date\" placeholder=\"\" name=\"date\">\n            <\/div>\n<div class=\"fields\">\n                <label for=\"TimeDischarge\">Time Discharge Discovered:<\/label><br \/>\n                <input type=\"text\" id=\"TimeDischarge\" placeholder=\"\" name=\"TimeDischarge\">\n            <\/div>\n<\/p><\/div>\n<div class=\"form-inline\">\n<div class=\"fields\">\n                <label for=\"DateLastRain\">Date of Last Rain Event:<\/label><br \/>\n                <input type=\"date\" id=\"DateLastRain\" placeholder=\"\" name=\"DateLastRain\">\n            <\/div>\n<div class=\"fields\">\n                <label for=\"EstimatedRain\">Estimated Quantity of Rain (in.):<\/label><br \/>\n                <input type=\"text\" id=\"EstimatedRain\" placeholder=\"\" name=\"EstimatedRain\">\n            <\/div>\n<\/p><\/div>\n<div class=\"form-inline\" style=\"margin-top: 20px\">\n            <label for=\"LocationDischarge\">Location of Discharge (indicate nearby street intersections, addresses and\/or landmarks for reference):<\/label>\n        <\/div>\n<div class=\"form-inline\">\n            <textarea id=\"LocationDischarge\" name=\"Locations of Discharge\" rows=\"3\" cols=\"100\"><\/textarea>\n        <\/div>\n<div class=\"form-inline\" style=\"margin-top: 20px\">\n            <label for=\"DischargeFound\">Where was discharge found?<\/label><br \/>\n                <input type=\"checkbox\" id=\"DischargeFound\" name=\"Discharge Found\" value=\"Open Ditch\">Open Ditch<br \/>\n                <input type=\"checkbox\" id=\"DischargeFound\" name=\"Discharge Found\" value=\"Stream\" style=\"margin-left: 30px;\">Stream<br \/>\n                <input type=\"checkbox\" id=\"DischargeFound\" name=\"Discharge Found\" value=\"Pipe Outfall\" style=\"margin-left: 30px;\">Pipe Outfall<br \/>\n                <input type=\"checkbox\" id=\"DischargeFound\" name=\"Discharge Found\" value=\"Other\" style=\"margin-left: 30px;\">Other:<br \/>\n            <\/label>\n        <\/div>\n<div class=\"form-inline\">\n            <label for=\"WaterFlowObserved\">Was water flow observed?<\/label><br \/>\n                <input type=\"radio\" id=\"WaterFlowObserved\" name=\"Water Flow Observed\" value=\"no\">No<br \/>\n                <input type=\"radio\" id=\"WaterFlowObserved\" name=\"Water Flow Observed\" value=\"yes\" style=\"margin-left: 30px;\">Yes<br \/>\n            <\/label>\n        <\/div>\n<div class=\"form-inline\">\n            <label for=\"FlowSolidPulsing\">Was flow solid or pulsing?<\/label><br \/>\n                <input type=\"radio\" id=\"FlowSolidPulsing\" name=\"Flow Solid Pulsing\" value=\"Solid\">Solid<br \/>\n                <input type=\"radio\" id=\"FlowSolidPulsing\" name=\"Flow Solid Pulsing\" value=\"Pulsing\" style=\"margin-left: 30px;\">Pulsing<br \/>\n            <\/label>\n        <\/div>\n<div class=\"form-inline\">\n            <label for=\"PhotoTaken\">Was a photo taken?<\/label><br \/>\n                <input type=\"radio\" id=\"PhotoTaken\" name=\"Photo Taken\" value=\"no\">No<br \/>\n                <input type=\"radio\" id=\"PhotoTaken\" name=\"Photo Taken\" value=\"yes\" style=\"margin-left: 30px;\">Yes<br \/>\n                <input type=\"file\" id=\"fileToUpload\" name=\"fileToUpload\" style=\"margin-left: 30px\"><br \/>\n            <\/label>\n        <\/div>\n<div class=\"form-inline\">\n            <label for=\"Odor\">Odor:<\/label><br \/>\n                <input type=\"radio\" id=\"Odor\" name=\"Odor\" value=\"None\">None<br \/>\n                <input type=\"radio\" id=\"Odor\" name=\"Odor\" value=\"Musty\" style=\"margin-left: 30px;\">Musty<br \/>\n                <input type=\"radio\" id=\"Odor\" name=\"Odor\" value=\"Sewage\" style=\"margin-left: 30px;\">Sewage<br \/>\n                <input type=\"radio\" id=\"Odor\" name=\"Odor\" value=\"Rotten Eggs\" style=\"margin-left: 30px;\">Rotten Eggs<br \/>\n                <input type=\"radio\" id=\"Odor\" name=\"Odor\" value=\"Sour Milk\" style=\"margin-left: 30px;\">Sour Milk<br \/>\n                <input type=\"radio\" id=\"Odor\" name=\"Odor\" value=\"Other\" style=\"margin-left: 30px;\">Other<br \/>\n            <\/label>\n        <\/div>\n<div class=\"form-inline\">\n            <label for=\"Color\">Color:<\/label><br \/>\n                <input type=\"radio\" id=\"Color\" name=\"Color\" value=\"Clear\">Clear<br \/>\n                <input type=\"radio\" id=\"Color\" name=\"Color\" value=\"Red\" style=\"margin-left: 30px;\">Red<br \/>\n                <input type=\"radio\" id=\"Color\" name=\"Color\" value=\"Yellow\" style=\"margin-left: 30px;\">Yellow<br \/>\n                <input type=\"radio\" id=\"Color\" name=\"Color\" value=\"Brown\" style=\"margin-left: 30px;\">Brown<br \/>\n                <input type=\"radio\" id=\"Color\" name=\"Color\" value=\"Green\" style=\"margin-left: 30px;\">Green<br \/>\n                <input type=\"radio\" id=\"Color\" name=\"Color\" value=\"Grey\" style=\"margin-left: 30px;\">Grey<br \/>\n                <input type=\"radio\" id=\"Color\" name=\"Color\" value=\"Other\" style=\"margin-left: 30px;\">Other<br \/>\n            <\/label>\n        <\/div>\n<div class=\"form-inline\">\n            <label for=\"Clarity\">Clarity:<\/label><br \/>\n                <input type=\"radio\" id=\"Clarity\" name=\"Clarity\" value=\"Clear\">Clear<br \/>\n                <input type=\"radio\" id=\"Clarity\" name=\"Clarity\" value=\"Cloudy\" style=\"margin-left: 30px;\">Cloudy<br \/>\n                <input type=\"radio\" id=\"Clarity\" name=\"Clarity\" value=\"Opaque\" style=\"margin-left: 30px;\">Opaque<br \/>\n            <\/label>\n        <\/div>\n<p><b>Was there a(n):<\/b><\/p>\n<div class=\"form-inline\">\n            <label for=\"OilySheen\">Oily Sheen:<\/label><br \/>\n                <input type=\"radio\" id=\"OilySheen\" name=\"Oily Sheen\" value=\"Yes\">Yes<br \/>\n                <input type=\"radio\" id=\"OilySheen\" name=\"Oily Sheen\" value=\"No\" style=\"margin-left: 30px;\">No<br \/>\n            <\/label>\n        <\/div>\n<div class=\"form-inline\">\n            <label for=\"GarbageSewage\">Garbage\/Sewage:<\/label><br \/>\n                <input type=\"radio\" id=\"GarbageSewage\" name=\"Garbage\/Sewage\" value=\"Yes\">Yes<br \/>\n                <input type=\"radio\" id=\"GarbageSewage\" name=\"Garbage\/Sewage\" value=\"No\" style=\"margin-left: 30px;\">No<br \/>\n            <\/label>\n        <\/div>\n<div class=\"form-inline\">\n            <label for=\"WasThereOther\">Other:<\/label><\/p>\n<p>            <\/label>\n        <\/div>\n<div class=\"form-inline\">\n            <label for=\"AdditionalInfo\">Additional information to assist in the investigation:<\/label>\n        <\/div>\n<div class=\"form-inline\">\n            <textarea id=\"AdditionalInfo\" name=\"Additional Info\" rows=\"3\" cols=\"50\"><\/textarea>\n        <\/div>\n<a href=\"https:\/\/pittstontownship.org\" class=\"su-button su-button-style-soft\" style=\"color:#000000;background-color:#44ef2d;border-color:#37c024;border-radius:5px\" target=\"_self\"><span style=\"color:#000000;padding:0px 16px;font-size:13px;line-height:26px;border-color:#7df46c;border-radius:5px;text-shadow:0px 0px 0px #000000\"> Submit<\/span><\/a><\/form>\n","protected":false},"excerpt":{"rendered":"<p>Name: Contact Phone Number: Date: Time Discharge Discovered: Date of Last Rain Event: Estimated Quantity of Rain (in.): Location of Discharge (indicate nearby street intersections, addresses and\/or landmarks for reference): Where was discharge found? Open Ditch Stream Pipe Outfall Other: Was water flow observed? No Yes Was flow solid or pulsing? Solid Pulsing Was a &hellip;<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-5474","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/pittstontownship.org\/index.php?rest_route=\/wp\/v2\/pages\/5474","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pittstontownship.org\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/pittstontownship.org\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/pittstontownship.org\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/pittstontownship.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=5474"}],"version-history":[{"count":7,"href":"https:\/\/pittstontownship.org\/index.php?rest_route=\/wp\/v2\/pages\/5474\/revisions"}],"predecessor-version":[{"id":5642,"href":"https:\/\/pittstontownship.org\/index.php?rest_route=\/wp\/v2\/pages\/5474\/revisions\/5642"}],"wp:attachment":[{"href":"https:\/\/pittstontownship.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=5474"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}