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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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