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Building and Grounds Maintenance Request

Stephens County Department Heads (or designated representative) are required to use this form for all normal maintenance requested on buildings, buildings equipment, and/or grounds. In the event of an emergency situation or computer access is unavailable; it is permissible to call Building and Grounds Maintenance Director (in this event); please submit this form ASAP as a follow-up and record of maintenance activity.

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Date Problem Noticed: *
MM-DD-YYYY
Time Problem Noticed:
Please enter the exact location where the problem was noticed
Location: *
Nature of Problem: *
Details: Please enter any further details that will help identify where the problem is located, who may be responsible, or why it may be occurring.
Details:

You may enter your name and address, but it is not required. However, if you would like a personal response, please provide your email address, a daytime phone number or a postal mailing address.

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Name:
Address:
Phone Number:
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