2. Violation
   (i.e. Speed/Stop Signs/etc)
4. Time(s) Occurring
5. Day(s) Occurring
7. Specific Location
9. Specific Information Describing the Problem and Observations
11. Name
12. Email Address
14. Phone Number
15. Fax Number
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17. 1. Receive an email copy of this form.
18. Email address

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19. Submit

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