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2. Can Supervisor Diane Burgis assist you by looking into a question or concern relating to Contra Costa County?

   If you would like assistance, please complete the form below providing the question or description of the problem, including any action you have already taken to resolve it.

   Your information will be forwarded to the appropriate staff member who will contact you to clarify and resolve matters.

   Thank you for allowing us to serve you.
   
4. Name:*
6. Telephone Number:
8. Email:
10. Street Address:*
12. City:*
14. State:*
16. Please describe your issue here:*
Leave This Blank:


18. 1. Receive an email copy of this form.
19. Email address

    This field is not part of the form submission.

20. Submit

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