North Shore Mosquito Abatement District
Standing Water Report Form
The NSMAD is interested in finding and locating potential breeding sites. This
form will help us with our Larvaciding program and our control efforts in treating
standing water throughout the district. If you could please fill out the following
information and when finished please click on the "Send Form" button below.
Your information is greatly appreciated.
If you would like to leave a message instead with the NSMAD district
office,  @ (847) 446 - 9434:  Please Press/Enter in THREE(3) anytime
during the welcome message and Report your Potential Breeding Site.
Standing Water Report Form:(That Stands for seven days or more):
If "Catch Basin": is Checked Above, Please Select # Found:
Please Give A Brief Description of the Breeding Site(s) Location(s):
_____________________________________________________________________________________
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© 2008 NSMAD

If you have any additional type of information
that you would like to share with us, Please E-Mail Us @: nsmad@nsmad.com
 
Name:
Telephone#:
Email Address:
Location of Standing Water:
Address:
City:
Type of Mosquito Breeding Site(s):
Catch Basin
Artificial Pond
Construction Site
Bird Bath
Drainage Ditch
Forest Area
 Old Tires
Roadside Ditch
Swimming Pool
 Tire Ruts
Yard Depression
Other