2. Date*
   Date

   Date
   Enter Date and Time
4. Name
5. Phone
7. Address*
   Enter Street Address, City and State
8. Zip code*
   -- Select One --71101711027110371104711057110671107711087110971115711187111971129

   Select Zip code
10. Email (optional)
11. What office did you contact?*
    -- Select One --Fleet Services - 673-7450Permits & Inspections - 673-6181Property Standards -673-6200Republic Services - 213-5087Solid Waste - 673-6300Streets & Drainage - 673-6330Traffic Engineering - 673-6181

    Let us know what office and/or phone number you contacted.
13. What was the nature of your contact with the Department of Public Works?*
    -- Select One --Requesting a service.Requesting information about services.Reporting a problem.Other

    Please select the reason that closest meets the reason for your call.
15. How would you rate your overall experience with the Department of Public Works*

    1. Excellent

    1. Good

    1. Poor

    Select the box that most accurately describes your experience.
17. Were we courteous and helpful?*

    1. Yes

    1. No
18. Did we adequately answer your questions and follow up as necessary (if applicable)?*

    1. Yes

    1. No
20. If you answered No to any of the above questions, please explain here.
    Enter additional information here that explains your experience.
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