Adopt-a-Highway - Report Your Pickup

NOTE: Please submit a separate report for each pickup date.

Permit Number:

Group Name:

E-mail address:

Confirm e-mail address:

City or county:

Date of Pick Up:

Number of participants:

Work Hours:

Number of Trash Bags:

Items found:

Unusual Items:

Comments:

Possible Error in Form

(Hours X Participants)

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Page last modified: Nov. 1, 2019