Association or Individual Name
Address*
City*
State*
Zipcode*
Telephone*
Email Address*
Date of cleanup
Adopted Area
County
Check one
Number of volunteers
Total volunteer hours
Cubic yard(s) of trash removed
3 ft x 3 ft x 3 ft = 1 cu yd
One pickup load = 3 cu yds
One refrigerator = 1 cu yd
Four tires = 1 cu yd
Six large trash bags = 1 cu yd
*Based on industry standards
Number of tires removed
Number of large appliances removed
Amount of trash recycled:
Special equipment used
Equipment donated by
Have you cleaned this site in the past?
Were any legal contacts made because proof of illegal dumping was obtained?
Were any names, address, or other identification found?
If yes, please specify
Any unusual findings
Name of local newspaper
Where did you hear about the Adopt-a-Forest program?
Additional comments:
