(Sample) Public Works - pothole / street service request
Mar 30, 2017
submission
#7
Submit request
Constituent Information (so that we may respond to your concern)
| Constituent Name | --- |
| Contact preference | Neither / no information |
Area of concern / repair request
| Address | 1201 W Whittier Blvd, Montebello, CA 90640 |
| Type of issue | Graffiti |
| Please describe the problem | Graffiti on the walls |
| Upload a picture | Sample_Form_citygrows.pdf |
Internal tracking
Resolution
| Picture - before | --- |
| Picture - after | --- |
| List activities | drilled , patched pothole |
| Notes | ground concrete, pruned roots and repoured concrete |