Storm Drain Cleaning Log

Adopter Information

Individual/Family

Organization/Business

Organization/Business Name

Storm Drain Location (nearest address point)

Amount collected/removed from drain. Please include the units of measure (for example: gallons or pounds)

Items collected (check all that apply)

Leaves/twigs/organic litter

Recycling (Plastic bottles, paper, etc)

Cigarette butt(s)

Broken Glass

Straws

Other

Other (please list)

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