Regulatory-Pollution Notification Form

Use this form for notifying Council of a reportable pollution incident that is causing or threatening material harm as required under Section 148 of the Protection of Environment Operations Act 1997.

Protecting your privacy

Council is committed to protecting your privacy and takes reasonable steps to comply with all relevant legislation. The information is collected by Council for the purpose of processing your application. Your personal information will be stored in accordance with relevant legislation and will only be accessed by authorised Council Staff.  If you do not provide information, Council may not be able to process your application.  Your information can be checked for accuracy by contacting Council on 02 4974 2000.

Preferred method of contact:

Is the polluter licensed with the EPA?:

Pollution cause:

Pollution impact upon:

Include cause if known
Who else has been contacted: