Biomedias - Testimony

By filling out the form below, you can help us track pollution.

Testimony Biomedias

Name(Required)

Surname(Required)

Email(Required)

About the collection

Date of collection :

Type of collection

Beach, river …

Location (name of the beach / city / country)

Latitude

Longitude

Are you aware of any exceptionnal/unusual events in this area (high tides, floods, storms…) ?

Are you aware of any failure in a wastewater treatment plant in your area ?

About the collection

Are you aware of any failure in a wastewater treatment plant in your area ?

Type 1

Type 2

Type 3

Type 4

Type 5

Type 6

Type 7

Type 8

Type 9

Type 10

Type 11

Type 12

Type 13

Type 14

Type 15

Type 16

Type 17

Type 18

Type 19

Type 20

Type 21

Type 22

Type 23

Type 24

Type 25

CAPTCHA

Phone

This field is for validation purposes and should be left unchanged.