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Adopt-A-Road Program

Productivity Report

Please complete the following form.
 

Clean Up Date

Adopted Road


From


To


Number of Volunteers


Number of hours worked


Total man hours


Number of bags filled


Other miscellaneous trash removed


Order Supplies

Bags (boxes) Qty.


Safety Vests Qty.


Pick Up Sticks Qty.


Report submitted by:

Name


Title


Organization


Day Phone


Fax


Email


Names of   Volunteers who
participated in this clean up
Mailing   Address Hours
Worked
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