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Cleanup Report
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* Indicates required question
Group Name
*
Your answer
Date of Cleanup
*
MM
/
DD
/
YYYY
Highway Location: (Highway Name, Route #, Mile Marker)
*
Your answer
Will you need Rubbish Bag Removal?
*
If yes, our maintenance crew will take care of bag disposal for you. If no, please email
stormwatermaui@gmail.com
with the number of bags you disposed of.
Yes
No
Number of Participants
*
Your answer
Number of Trash Bags Used
*
Your answer
Hazardous materials, large items, or dead animals:
List any of the above that need to be picked up by our crews (leave them in place) and specify location:
Your answer
Group Representative's Digital Signature
*
(Type your name)
Your answer
Today's Date
*
MM
/
DD
/
YYYY
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