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Collection Statistics Form

  1. Enter the day of clean up.

  2. List Name of Organization as Listed on Contract If Applicable

  3. List Adopter Area Number or Detailed Road Explanation

  4. Enter the total bags collected.

  5. Enter the estimated weight in LBS of oversized or odd items.

    Please round to the nearest half-hour:

  6. List the approximate distance cleaned in miles. Your route x2.

  7. Leave This Blank:

  8. This field is not part of the form submission.