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2. Contact Information (Optional)
4. First Name
6. Last Name
8. Contact Phone
10. Email
12. Types of Drug(s) If Known:
14. Where Did You See This Drug Activity?*
16. Street Address or Cross Streets*
18. City
    -- Select One --1000 PalmsAguangaAlberhillAndreas HillsAnzaArabiaArlanzaArlingtonBanningBeaumontBelltownBermuda DunesBlytheCabazonCahuillaCalimesaCanyon CrestCanyon LakeCanyon SpringsCasa BlancaCathedral CityCherry ValleyChiriaco SummitChuckwalla MountainsCoachellaColorado Indian ReservationCoronaCoronitaCottonwood SpringDe LuzDesert BeachDesert CenterDesert HavenDesert Hot SpringsEagle MountainEast BlytheEast HemetEastvaleEdgemontEl CarisoEl CerritoFlowering WellsFrench ValleyGarner ValleyGarnetGillman Hot SpringsGlen AvonGlen EdenGlen Ivy Hot SpringsGlen ValleyGood HopeGreen AcresHayfieldHemetHighgroveHome GardensHomeland (Hemet)Homeland (Perris)Hundred PalmsIdyllwindIndian WellsIndioIndio HillsJoshua TreeJuniper FlatsJurupa ValleyLa CrestaLake ElsinoreLake HillsLake MatthewsLake RiversideLakeland VillageLakeviewLa QuintaLa SierraLa Sierra HeightsMead ValleyMeadowbrookMeccaMenifeeMidlandMira LomaMoreno ValleMorongo Indian ReservationMountain CenterMurrietaMurrieta Hot SpringsNicholls Warm SpringsNorcoNorth Palm SpringsNorth ShoreNuevoOasisOrangecrestOrtega HillsPainted HillsPalm DesertPalm SpringsPechangaPedleyPerrisPine CovePine MeadowPinyon PinesPoppet FlatsQuail ValleyRancho CaliforniaRancho MirageRipleyRiversideRomolandRubidouxSageSalton SeaSan GorgonioSan JacintoSan Timoteo CanyonSedco HillsSky ValleySoboba Hot SpringsSoboba Indian ReservationSun City (Menifee)Sun City (Palm Desert)SunnymeadSunnyslopeTemeculaTemescal CanyonThermalThousand PalmsTwin PinesUniversity of CaliforniaUniversity CityValley VistaWarm SpringsWhitewaterWildomarWinchesterWoodcrest
19. When Did You See This Drug Activity?*
    When Did You See This Drug Activity?

    When Did You See This Drug Activity?
21. Describe Activity*
    If known, include suspect(s) name, description, vehicle description, license plate number, etc.
23. File Attachments
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25. 1. Receive an email copy of this form.
26. Email address

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