This feedback is regarding: |
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Date of Event: |
[ 8/6/2024 ]
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Time of Event (HHMM): |
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Route #: |
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Vehicle #: |
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Direction: |
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Location (Street and Cross Street): |
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Please
provide us with a brief description of the event:
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Are
you referring to an issue involving service for a person with
a disability? |
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Is this an issue
in which there is discrimination based on race, color or national origin (Title VI)?
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Contact Information:
Note: The below information is required if this report involves a claim of injury
or property damage, or if you are requesting to be contacted.
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First
Name: |
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Last
Name: |
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E-Mail
Address: |
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Verify E-Mail
Address: |
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Day Telephone #:
Enter Area Code:
Enter Prefix:
Enter Last 4 digits:
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Would you like to be contacted regarding this issue?
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