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Date of Report
Location of pothole: Please try to be as specific as possible about the location. List the nearest house or business address, the closest intersection, and whether the pothole is located in the north, south, east, or west bound lane.
Situation:
Severe Moderate Newly forming
Additional comments:
Please provide your contact information, this is in case we experience difficulties in locating the pothole.
Name:
Your telephone number:
Your e-mail address:
