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ACUA INFORMATION

RECYCLING/DISPOSAL

RENEWABLE ENERGY

ALTERNATIVE FUEL VEHICLES

WASTEWATER

WATER CONSERVATION
Adopt-A-Road Cleanup Summary Report

First Name:  
Last Name:  
Address Number: 
Direction:
Street Name: 
Street Type: 
City: 
Zip:  
State: 
E-mail:  
Phone:  
(xxx)xxx-xxxx
Name of Organization: 
Date of Cleanup: 
Location of Cleanup: 
How many volunteers participated in the cleanup?
 
How many hours spent on cleanup?
 
Approximately how much area was cleaned?
Miles: 
Area: 
How many bags of(non recyclable)litter?
 
How many bags of recyclable material?
 
How many tires? 
What other large objects were found that were not placed in bags? Describe below and give quantity.
Do you need the ACUA to pick up the bags?



Please verify your contact information, if you need to make changes click EDIT.

Organization:

First Name:

Last Name:

Address:

E-mail:

Phone: