Suggest a Clean Up Site Form

First name*

Last name*

Phone number*

Email*

Please type in the address or nearest address*

Please indicate the owner of the property (if known)

Are there any safety concerns to your knowledge (steep slopes, hazards, ect)? Please describe them if there are.*

Is there available parking?*

Yes

No

Please tell us how much debris or trash do you think is at this location. Estimate using numbers of trash bags or pick up loads.*

Do you know of a local community group that would be interested in supporting a clean up at this location?*

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