2. ESTABLISHMENT DETAILS
4. TYPE OF LOCATION:

   1. RESIDENCE
   2. BUSINESS
6. ADDRESS:
8. NUMBER
9. STREET
   -- Select One --Blank36TH ST37TH ST39TH ST40TH ST41ST ST42ND ST43RD ST44TH ST45TH ST46TH ST47TH ST48TH ST53RD ST55TH ST59TH ST61ST ST62ND ST63RD ST64TH ST67TH STACCESS STADELINE STADMIRAL DRANCHOR DRAPGAR STBAY STBEAUDRY STBOYER STCAPTAIN DRCHRISTIE AVECOMMOD DRDOYLE STEMERY DREMERY STENSIGN DRESSEX STFRONTAGE RDHALLECK STHARLAN STHAVEN STHOLDEN STHUBBARD STLACOSTE STMAGNOLIA STOCEAN AVEOVERLAND AVEPARK AVEPEABODY LNPELADEAU STPERALTA STPOWELL STSALEM STSAN PABLO AVESHELLMOUND STSHELLMOUND WAYSHERWIN STSTANFORD AVETEMESCAL CIRVALLEJO STMACARTHUR BLVDWATTS STYERBA BUENA AVEOAK CREEK WAYEMERY BAY DR
10. CITY
11. STATE
13. ZIP CODE
15. (IF APPLICABLE) BUSINESS NAME & TYPE:
17. SECURITY CAMERA DETAILS
19. NUMBER OF CAMERAS:
21. IS AUDIO RECORDED:

    1. YES
    2. NO
23. DESCRIBE AREAS RECORDED: (STREET FRONT/BACK ALLEY)
25. RETENTION PERIOD:
27. HOW MAY WE OBTAIN A COPY OF THE VIDEO IF NEEDED? :
29. CONTACT INFORMATION
31. RESIDENT OR BUSINESS OWNER'S FULL NAME:
33. CONTACT NUMBER.(RESIDENT OR OWNER) :
35. (AFTER HOURS) BUSINESS CONTACT & NUMBER :
37. SECURITY COMPANY :
39. SECURITY CONTACT :
41. EMAIL ADDRESS
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43. Submit

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