* indicates a required field

2. To request service from the Department of Public Works within the Blythe city limits, you may either:

   • request service in person at the Public Works office, located at 440 South Main Street, during normal business hours
   • call the Public Works office at (760) 922-6611. If your call is not immediately answered please leave a message with your name, phone number and a brief detailed message and someone will contact you as soon as possible
   • complete the fields below which will be submitted to Public Works

   This service request form will help us identify a problem in your area that needs service. Should a problem require urgent attention, please call us immediately. For police emergency dial 911.

   To report a street light outage contact Southern California Edison

   To report issues with your trash cans, or trash service, contact CR&R, Inc

   Thank you for your assistance.

4. Contact Information
6. First Name*
7. Last Name*
9. Address1*
11. Address2
13. City*
14. State*
15. Zip*
17. Phone Number*
18. Email Address*
20. Please indicate the nature of the problem by checking the appropriate box(es) below:
22. Parks

    1. Damaged Playground Equipment
    2. Damaged Sprinkler
    3. Overgrown Bush/Tree

    1. Restrooms
    2. Shrubs/Weeds
24. Streets

    1. Damaged Curb
    2. Damaged Sidewalk
    3. Faded Road Striping
    4. Loose/Protruding Manhole Cover
    5. Overhanging Tree/Bush in Public Right-of-Way
    6. Pothole

    1. Shrubs/Weeds in Public Right-of-Way
    2. Storm Drain Blockage
    3. Street Sign
    4. Traffic Sign
    5. Traffic Signal
26. Vector Control

    1. Mosquitoes
28. Water

    1. Damaged Meter Box
    2. Discolored Water
    3. Hydrant Leak

    1. Meter Leak
    2. Missing Meter Lid
    3. Water Leak in the Street
30. Sewer

    1. Sewer Blockage

    1. Sewer Leak
32. Detailed Description (or other problem not listed above)
34. Location of Problem
36. Has this previously been reported?
    -- Select One --NoYes
37. If yes, when?
    If yes, when?
Leave This Blank:


38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit Submit and Print

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