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2. Please fill out the information below to assist the Public Works Department with identifying the problem in your area and addressing it in a timely manner. Should a problem require urgent attention, 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 (626) 570-5072. For an emergency, dial 911.

   Thank you for your assistance!

4. Contact Information
6. First Name*
7. Last Name*
9. Address1*
11. Address2
13. City*
14. State*
15. Zip*
17. Phone Number*
18. Email Address*
20. Please indicate the nature of your problem by checking the appropriate box(es) below:
22. 1. Damaged Asphalt/Potholes
    2. Damaged curb & gutter
    3. Traffic signals
    4. Weeds
    5. Litter/debris in Public Right-of-Way

    1. Road striping
    2. Street Lights
    3. Damaged sidewalk
    4. Traffic/Road signs

    1. Overhanging trees/shrubs
    2. Street Sweeping
    3. Graffiti
    4. Other
24. Brief Description (or other problem not listed)
26. Location of Problem
Leave This Blank:


28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit

* indicates a required field