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Please state as specifically as possible what you think should be done to resolve the <br />grievance. <br />SIGNATURE DATE <br />MAIL, FAX OR EMAIL COMPLETED GRIEVANCE FORM TO: <br />Kathleen Ornelas or <br />ADA Coordinator <br />City of San Leandro <br />835 East 14th Street <br />San Leandro, CA 94577 <br />Phone: 510-577-3358 <br />Fax: 510-577-3340 <br />TTY: 510-577-3343 <br />kornelas@ci.san-leandro.ca.us <br />Steve Hernandez <br />Section 504 Coordinator <br />City of San Leandro <br />835 East 14th Street <br />San Leandro, CA 94577 <br />Phone: 510-577-6005 <br />Fax: 510-577-6007 <br />TTY: 510-577-3343 <br />shernandez@ci.san-leandro.ca.us <br />For City Use Only: <br />DATE GRIEVANCE WAS RECEIVED DATE GRIEVANCE INVESTIGATED <br />RESULTS OF INVESTIGATION (ATTACH SUPPORTING DOCUMENTATION OR PHOTOGRAPHS) <br />Method of Contact: ^ Phone <br />DATE COMPLAINANT CONTACTED INVESTIGATOR ^ Letter <br />^ Personal Visit <br />Revised October 2009 Page 2 of 2 <br />