2. 
3. Adopt-a-Street

   Post Cleanup Form

5. Select One:

   1. Adopted Streets

   1. Non-Adopted Streets
7. Date*
8. Street:*
10. Organization*
12. Name of Contact Person:*
13. Phone:*
15. Map location from city/county road map (if available):
16. Location of street section cleaned:

    If possible, please provide names of road crossings and/or attach a map.

18. Number of miles cleaned:
19. Number of adults who participated:
20. Number of children who participated:
22. Number of trash bags collected:
23. Type of trash collected:
25. Most unusual item found:
26. Clean-up time (in hours):
28. Location of Pick-up
30. Additional comments:
Leave This Blank:


32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit

* indicates a required field