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2. Spill Kit Request Form

   Privacy Notice: Information provided in this form is considered a public record and may be subject to public disclosure. For more information, see the Public Records Act, RCW Chapter 42.56.

   Fill out this form to request a free spill kit. 

   Always be prepared for a spill by having an up-to-date Spill Prevention and Cleanup Plan and a spill kit onsite. Staff who may encounter a spill should be familiar with the plan and you should post it in an easily accessible place. Your business must be within Bothell's city limits to be eligible for a free spill kit.

3. 
5. Business name

   What is the name of your business, as advertised?

6. Business address

   Physical address, including suite or unit number (if applicable), city, and zip

7. Contact person

   This is the person we will contact to schedule delivery of your spill kit

9. How should we contact you?

   What's the best way to reach you?

   1. Email me
   2. Call me
10. Email address
11. Phone number
13. What type of business is this?

    1. Restaurant / Food Service
    2. Automotive
    3. Beauty / Spa

    1. Manufacturing
    2. Construction
    3. Retail

    1. Professional Services
    2. Education
    3. Other
14. What type of business is this?

    If your business doesn't fit within one of the categories listed, enter your type of business

16. What are your business hours of operation?

    We can deliver spill kits between 8 a.m. and 4 p.m., Monday through Friday

17. Does your business have a Spill Prevention and Cleanup Plan?

    1. Yes
    2. No
    3. I don't know

    Your business needs to have a Spill Prevention and Cleanup Plan in place to be eligible for a free spill kit

18. Create a Spill Prevention and Cleanup Plan
    Spill Prevention and Cleanup Plan (fillable PDF)

    Use this template to create a Spill Prevention and Cleanup Plan for your business. The plan should be posted somewhere staff can easily see it.

20. What is your staff's preferred spoken language?
21. What is your staff's preferred written language?
23. Questions?

    If you have questions about the spill kit or if there is more information we should know about your business, please use this space

25. What happens next?

    If your business is within Bothell's city limits and you have a Spill Prevention and Cleanup Plan posted at your business, City of Bothell staff will contact you within 30 business days to arrange delivery of your spill kit. If we are out of spill kits, we will notify you and will add your business to a waitlist list for the next time we are able to restock the supply.

    If you have any questions in the meantime, please contact us.

27. Resources

    Click any of the links below for pollution prevention resources:

    • What do to if your business has a spill
    • How to use your spill kit
    • Best Management Practices (BMPs) to prevent spills and pollution
    • Create a Spill Prevention and Cleanup Plan (fillable PDF)
29. Limitations

    We can offer one free spill kit per qualifying business. You must have a Spill Prevention and Cleanup Plan posted at your business. Your business must be within Bothell's city limits (typically zip codes 98011 and 98021). If you are unsure whether your business is within Bothell's city limits, use this map to search your address. In the address results, you will see Jurisdiction: BOTHELL if you are within city limits. If it does not say BOTHELL, then you are not within city limits and are not eligible for a free spill kit.

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31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit

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