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2. The purpose of this form is to make the City aware of your desire to have a street resurfaced. Submitting this form does not prioritize the street for resurfacing or guarantee when it will be resurfaced in the future.
3. This form is to submit a request for street resurfacing of an entire block or blocks. To report a pothole or other small location in need of immediate repair, please call City Hall at 626-285-7187.
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Resurface Request Location

2. Street Name*
   -- Select One --Acacia StAcaso StAgnes AveAlessandro AveArden DrArdenel AveArdsley DrArrowood StAvon AveBaldwin AveBarela AveBartlett AveBidwell StBirchland PlBisby StBlackley StBogue StBroadwayBurghardt RdBurton AveButtons AveCallita StCambury AveCamellia AveCamino RealCloverly AveCraiglee StDaines DrDaineswood DrDaleview AveDanbury StDegas AveDoreen AveDuffy StDupuy CirEl Monte AveEllis LnElm AveEmperor AveEncinita AveEstrella AveFairhall StFairview AveFarago AveFiesta AveFlaherty StFortson DrFratus DrFreer StGaribaldi AveGidley StGlickman AveGolden West AveGracewood AveGrand AveGreen StGreen Tree LnHaldeman StHalifax RdHallowell AveHallwood DrHarker AveHart AveHecla AveHeleo AveHermosa DrHilton AveHowland DrIvar AveJaylee DrKauffman AveKennerly StKey West StLa Rosa DrLandseer StLas Tunas DrLemon AveLeslie DrLinden LnLive Oak AveLivia AveLoma AveLongden AveLora StLower Azusa RdLyledale StLynrose StMcClintock AveMcCulloch AveMiller DrMiloann StMuscatel AveMyda AveNadine StNoel DrOak AveOak StOlema StOlive CtOlive StPal Mal AveParmerton AvePentland StPersimmon AvePrimrose AveRancho Real RdRandwick DrReno AveRichmond WayRio Hondo AveRobinhood AveRoccus LnRoseglen StRosemead BlvdRosevale DrRowland AveRyland AveSaint James DrSalter AveSanta Anita AveSara Mar LnSereno DrSparklett StSultana AveTemple City BlvdTree Rose TerTrelawney AveVal StVillage Circle DrWarman LnWedgewood LnWedgewood StWelland AveWendon StWildflower RdWillmonte AveWindsor LnWoodruff AveWoolley StWorkman AveWorthington DrZadell Rd
3. Block Number(s)*
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Contact Information

2. Name*
4. Address*
5. Street Name*
   -- Select One --Acacia StAcaso StAgnes AveAlessandro AveArden DrArdenel AveArdsley DrArrowood StAvon AveBaldwin AveBarela AveBartlett AveBidwell StBirchland PlBisby StBlackley StBogue StBroadwayBurghardt RdBurton AveButtons AveCallita StCambury AveCamellia AveCamino RealCloverly AveCraiglee StDaines DrDaineswood DrDaleview AveDanbury StDegas AveDoreen AveDuffy StDupuy CirEl Monte AveEllis LnElm AveEmperor AveEncinita AveEstrella AveFairhall StFairview AveFarago AveFiesta AveFlaherty StFortson DrFratus DrFreer StGaribaldi AveGidley StGlickman AveGolden West AveGracewood AveGrand AveGreen StGreen Tree LnHaldeman StHalifax RdHallowell AveHallwood DrHarker AveHart AveHecla AveHeleo AveHermosa DrHilton AveHowland DrIvar AveJaylee DrKauffman AveKennerly StKey West StLa Rosa DrLandseer StLas Tunas DrLemon AveLeslie DrLinden LnLive Oak AveLivia AveLoma AveLongden AveLora StLower Azusa RdLyledale StLynrose StMcClintock AveMcCulloch AveMiller DrMiloann StMuscatel AveMyda AveNadine StNoel DrOak AveOak StOlema StOlive CtOlive StPal Mal AveParmerton AvePentland StPersimmon AvePrimrose AveRancho Real RdRandwick DrReno AveRichmond WayRio Hondo AveRobinhood AveRoccus LnRoseglen StRosemead BlvdRosevale DrRowland AveRyland AveSaint James DrSalter AveSanta Anita AveSara Mar LnSereno DrSparklett StSultana AveTemple City BlvdTree Rose TerTrelawney AveVal StVillage Circle DrWarman LnWedgewood LnWedgewood StWelland AveWendon StWildflower RdWillmonte AveWindsor LnWoodruff AveWoolley StWorkman AveWorthington DrZadell Rd
6. Unit No.
8. Phone Number
9. Email
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11. Email address

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