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2. If you have a speed or traffic complaint that you wish to report please complete the form below to submit it to the Pleasant Hill Police Department. Department will not accept forms that do not include contact information.
4. Location of traffic complaint
6. Approximate time incident is occuring?
   Approximate time incident is occuring?
9. Contact Information:
11. First Name
12. Last Name
14. Address1
16. Address2
18. City
19. State
20. Zip
22. Email address
24. Phone
26. If needed, may the Pleasant Hill Police Department utilize your driveway to follow up on this complaint?

    1. Yes

    1. No
28. Would you like the Pleasant Hill Police Department to contact you regarding the response and status of this complaint?

    1. Yes

    1. No
30. Is a particular vehicle involved in the reoccuring problem?

    1. Yes

    1. No
32. If yes, please provide a further description of the vehicle:
34. Make/Model:
36. Color:
38. Plate:
40. Please provide any additional information or comments relating to your complaint.
Leave This Blank:


42. 1. Receive an email copy of this form.
43. Email address

    This field is not part of the form submission.

44. Submit

* indicates a required field