Pollution Incident
River:	Map Reference:			Weather Conditions (Tick conditions that apply)
				Bright		Dull		Rain	Snow
Fish Kill Yes No	Rough Estimate Salmon Sea Trout Brown Trout Grayling Minnows Stone Loach Other Species
Date of Incident		Time of incident	SEPA Contacted Yes No				Name of SEPA Rep.
Pollution Source					Type of Pollution
Remarks
Incident reported by: