Atlantic County Utilities Authority

Cleanup Summary Report

* Required field! Please fill in the correct information.

Name of Organization:

Contact Person:

Phone:

Email:

Address:

Date of Cleanup: (mm/dd/yyyy)

Location of Cleanup:

How many volunteers participated in the cleanup?

Approximately how much area was cleaned?

Miles:

or Areas:

How many hours spent on clean up?

How many bags of (non recyclable) litter?

How many bags of recyclable material (glass/aluminum/plastic)?

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? Yes No

If so, where are the bags located?

Yes, please include me in any email offers/specials!