City of Long Beach: Clean Water Division

<%@LANGUAGE="VBSCRIPT"%> <% if (cStr(Request("Submit")) <> "") Then Dim objCDO Set objCDO = Server.CreateObject("CDONTS.NewMail") objCDO.From = "admin@iwda.org" objCDO.To = "Tom_Leary@ci.long-beach.ca.us" objCDO.CC = "" objCDO.Subject = "Storm Drain Dumping Report" objCDO.Body = "The following information was reported via the Long Beach Clean Water Division Online Reporting Tool:" & chr(10) & chr(13) & "Type of Materials Dumped: " & Request.Form("TypeMaterials") & chr(10) & chr(13) & "Time/Date Dumping Occurred: " & Request.Form("Time") & " " & Request.Form("Month") & " " & Request.Form("Day") & chr(10) & chr(13) & "Address/Cross-Street of Dumping: " & Request.Form("Address") & chr(10) & chr(13) & "Vehicle Plate Number: " & Request.Form("VehiclePlate") & chr(10) & chr(13) & "Business Name: " & Request.Form("BizName") & chr(10) & chr(13) & "Additional Comments: " & Request.Form("AddlComments") & chr(10) & chr(13) & "Full Name: " & Request.Form("FullName") & chr(10) & chr(13) & "Daytime Phone: " & Request.Form("DaytimePhone") & chr(10) & chr(13) & "E-Mail Address: " & Request.Form("Email") & chr(10) & chr(13) objCDO.Send() Set objCDO = Nothing Response.Redirect("thankyou.asp") End If %> City of Long Beach: Clean Water Division

Report Storm Drain Dumping Online

STOP! If you are witnessing someone dumping into the storm drain system or if you see hazardous materials (paint, oil, gasoline, antifreeze) in or near the storm drain DO NOT FILL OUT THIS FORM! PLEASE CALL 911 IMMEDIATELY.

To report non-hazardous materials (pet waste, green waste, construction waste) please complete the following:

Type of materials dumped:

When did it occur?

Address or Cross-Street of dumping activity:

Vehicle plate number:

Commercial Business/Name:

Additional Comments:

The rest of this form is optional and any information you submit will remain confidential. However, it may be necessary to contact you if additional information is needed.

Name (First & Last):

Daytime Phone Number:

E-Mail Address:



© 2001 by The City of Long Beach, California, All Rights Reserved

570-DUMP:
Report Storm Drain Dumping!

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