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Vector Complaint Request Form



Report a problem with: - Please Select Only One Per Complaint Request - Mosquitoes Midges Blackflies Flies Gnats Bats Bees Ticks Cockroaches Bedbugs Rats/Mice (Vermin) Other Rodents Ground Squirrels Horses & Other Livestock Sanitation

NOTE: Dead bird reporting and pickup requests are handled by the California West Nile Virus hotline. Please visit their site at http://westnile.ca.gov/ report_wnv.php or dial 1-877-WNV-BIRD (1-877-968-2473) to report a dead or sick bird.

Please describe the situation:

Are you receiving mosquito bites? Yes No



Are you seeing mosquitoes: Indoor Outdoor Both No



Is there standing water that could be breeding mosquitoes at the location? Yes No

What type of water source is it? Swimming Pool Pond Creek Ornamental pond Channel Gutter Stagnant Water Other (describe) Please, select all that apply.



If you chose the option "other", please describe below:

Your Contact Info: First Last

Your Phone Number:

Your Email:



Location of the problem:



What type of facility is the problem occurring at? - Select - Single-family home Multiple unit housing (Apartment, townhouse etc) Commercial property (business, office, etc) Other





Please describe the property type:

Do you live here? Yes No



Address of the problem: Address to report Address 2 City/Town ZIP/Postal Code