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2. Date and time of incident
   Date and time of incident

   Date and time of incident
   Please approximate the date and time the waste was noticed
4. Address or Location
   Please provide an address or approximate location (cross streets, name of facility, etc.)
6. Additional information
   Please provide any relevant additional information regarding this incident
8. Thank you for providing us with this information, we will make every effort to contact the responsible parties to reduce water waste in Lodi.
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10. 1. Receive an email copy of this form.
11. Email address

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