Adopt-a-Highway

* Permit number: [REQUIRED]



Group name:



* E-mail address: [REQUIRED]



* County: [REQUIRED]



Date of pickup:



Number of participants:



Number of work-hours (hours times participants):



Number of trash bags:



Items found (Press <CNTRL + Click> to multi-select):
Beer and soft drink cans Plastic/Styrofoam/fast food containers Glass containers Rubber items Cigarettes/Tobacco Products Newspaper/Magazines All of the above Other

Unusual items found:

 

Bag Pickup? YES No