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2. YOU MAY USE THIS FORM TO REPORT A CONCERN WITH A TRAFFIC SIGNAL. IF THE SIGNAL PRESENTS AN IMMEDIATE SAFETY HAZARD, PLEASE CALL 779-2101.
4. PLEASE ENTER THE FOLLOWING CONTACT INFORMATION:
   
6. Email address:
8. First Name:*
10. Last Name:*
12. Phone Number:
14. How do you wish to be contacted:*
    -- Select One --emailphone
16. Nearest street or address:*
18. Nearest intersection or cross street:*
20. Please enter any additional directional information to help us locate the malfunctioning signal:
22. 
    
24. Problem you are reporting:*
    -- Select One --Light is burned outLight is flashingLight is damagedDamaged poleSensor problem
26. 
    
28. Other problem (be as descriptive as possible):
Leave This Blank:


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

    This field is not part of the form submission.

32. Submit

* indicates a required field