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*Date: MM/DD/YYYY Your Name: Your Address: City: Zip Code: *Address/City: Location of Hazard *Cross Streets: *Nature of the Hazard: (e.g., overgrown, weeds,brush, rubbish)(Limit:100 characters) Counter:
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District
Supervisor
1st
Gloria Molina
Mark Ridley-Thomas
3rd
Zev Yaroslavsky
Don Knabe
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