City of Merced RQ#: 21-032
Citizen Action Request Form: Traffic Committee
Contact Person: Michael Beltran Day Phone:
Email Address:
Address: N St. - 16th St. to 18th St. Today's Date: 10/19/21 Location of Concern (map attachments and photographs are encouraged):
Describe Concerns At This Location:
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For Official Use Only:
Project #: Date Received: Date Field Inspected:
Field Inspection Results:
Date Response To Contact Person:
Resolution of Concern:
Date Completed:
Traffic Engineer's Signature or Designee Date