Including the current lock level of the segment allows editors to see at a glance if they are a high enough rank to address the request, and adding the name of the segment helps differentiate between multiple requests from the same editor in the same city. I would recommend this format:
Level 4 unlock in Winnipeg, Manitoba (Main St)
If the segment doesn't have a city name, there shouldn't be a comma before the state:
Level 4 unlock in Manitoba (Hwy 9)
If the segment doesn't have a street name, the parentheses should be omitted:
Level 4 unlock in Winnipeg, Manitoba
Level 4 unlock in Manitoba