City of Merced
Citizen Action Request Form: Traffic Committee
Contact Person: _____________________________________ Day Phone: __________________
Email Address:_________________________________________________________________
Address: ___________________________________________________ Today’s Date: ________________
Location of Concern (map attachments and photographs are encouraged):
____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________
Describe Concerns At This Location: ______________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________
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
RQ#:
DIAGRAMS
Location of Concern North
General Diagram
North
CHILDS AVE
ACCESSIBLE PARKING STALL
CHILDS AVE
NO PARKING
3 HOUR PARKING