Solid Waste/Illegal Dumping Complaint Form

Witness Information
Name
First Last
Email*
Company or Agency, if applicable
Home Phone*
Work Phone
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Incident Information
Incident Date*
MM slash DD slash YYYY
Incident Time

: Hours

Minutes

AM/PM
License Plate Number
Vehicle Description
Incident Location (must be in Clark County)
Violator's Description
Material Dumped*
Other Pertinent Information
CAPTCHA
Name
This field is for validation purposes and should be left unchanged.

Updated on: June 5, 2019

Witness Information