SAFE Call Box Action Form
(San Bernardino County Call Boxes)

Contact Information

Tell Us Your Name, Organzation and Affiliation:

*Name:

*Organization:

*email address:

Affiliation:

Caltrans

Construction

Maintenance

Right-of-Way Utilities

Permittee

Permittee Section

If you are not a permitee, continue to the Action Needed Section.

SAFE may charge Permittee for
the cost of:

Permittee Address:

City:

State:

ZIP code:

Business Phone:
(with area code)

Fax:
(with area code)

Additional Description/Comment:

Action Needed

Please include Call Box numbers. Remember, both boxes may be affected.

About Call Box Numbers...
Call box numbers are shown on the call box sign. This number identifies both the box and its location. For example, SB10-93 is the number for a San Bernardino County call box on WB (because the last number is odd), route 10 at post mile 9, first quarter mile.

Call Box Numbers:

Action:

Temporary removal from service: Bagging ONLY - needed by date:
If K-Rail will block access or the shoulder will be too narrow during construction only.

Temporary removal of box and pole ONLY. Needed by date:
(If equipment is working close to the box.)

Removal of box, pole, pad, auger, and any retaining walls.
Needed by date:

Relocation. Needed by date:

(If MBFR, etc. will permanently affect/block access.)

Place boxes back in service.