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2. 
4. Please fill out the information below to assist us with identifying the problem in your area and addressing it in a timely manner. For request related to the Public Works Department, please call (626) 570-5067 during business hours Monday through Thursday, 7:00 am until 5:30 pm. For traffic signal/streetlight issues after business hours, please call (800) 229-6090. For issues concerning the Code Enforcement Division, please call (626) 570-3230 during business hours.For a police emergency, dial 911. Thank you for your assistance!
6. Contact Information
8. Full Name*
10. Email Address*
12. Phone Number
14. Please indicate the nature of your problem by checking the appropriate box(es) below:
16. 1. Damaged Asphalt/Potholes
    2. Damaged curb & gutter
    3. Traffic signals
    4. Weeds
    5. Litter/debris in Public Right-of-Way
    6. Road striping
    7. Street Lights
    8. Damaged sidewalk
    9. Traffic/Road signs
    10. Overhanging trees/shrubs
    11. Street Sweeping

    1. Graffiti
    2. Overgrown vegetation / weeds/ dry grass on private property only
    3. Junk and discards on private property only
    4. Trash cans in public view or on non-trash collection days only
    5. Canopy or temporary coverings in the front yard or on the property line
    6. Deteriorated exterior or buildings on private property only
    7. Illegal construction without building permits
    8. Illegal signage displayed on private property
    9. Unfenced or unsecured pool or body of water
    10. Other
18. Brief Description (or other problem not listed)*
20. Location of Problem (Street name, address or block number)*
22. Optional: Upload Image or Document Here
24. Optional: Upload Image or Document Here
26. Optional: Upload Image or Document Here
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28. 1. Receive an email copy of this form.
29. Email address

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30. Submit

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