1. Please describe the drug problem you are encountering.

  2. When is this occurring?            Day           Night
     
                                 Time (s) :
                                           
  Day(s) occurring:    (Check each that apply)

  3. Can you be specific on the location where this is occurring? (Address?)

  4. Do you know the names of the persons involved? (street name, nicknames, Race,   Sex, Height, weight, hair color, age, where they live if other than # 3)


  5. Please list pager numbers, cell or home phone numbers of subjects involved in this   activity, if known.



  6. Are vehicles being used by subjects? Do you know the tag #? Please describe the   vehicle (car, truck, etc, make, model, year, color, etc)


  7.Can we talk with you? If yes, include the following information.
  Name
  email address
  phone #