Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

Spill Kit Request Form

  1. Spill Kit Request Form

    Privacy NoticeInformation 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.

  2. City of Bothell Logo
  3. What is the name of your business, as advertised?

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

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

  6. How should we contact you?

    What's the best way to reach you?

  7. What type of business is this?
  8. If your business doesn't fit within one of the categories listed, enter your type of business

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

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

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

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

  12. 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.

  13. Resources
  14. 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.

  15. Leave This Blank:

  16. This field is not part of the form submission.