Rubbish Removal Request Form (O'AHU ONLY)
Mahalo nui loa for holding a cleanup event! Please read the reminders below before you complete your form.

1) Rubbish Removal Requests should be submitted within 2 days of the cleanup event.
2) Please include the number trash bags that need to be picked up and indicate if they are NOT the orange AAH bags (e.g. black contractor bags).
3) Describe the location(s) that trash bags were left.
4) Please specify if there are any bulk items, hazardous materials, or dead animals. Leave them in place and provide the location.

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What is your Adopt-A-Highway Group Number? *
Your Adopt-Highway Group Number is 6 digits (e.g. AAH-001).
What is your Adopt-A-Highway Group Name? *
What is the route name and number of the segment that you cleaned? E.g. Kalanianaole Hwy (Route 72) *
First Name *
Last Name *
Phone Number *
Please provide 10-digit number with dashes (e.g. 808-123-4567)
Email
Please provide your preferred email address
Date of Cleanup Event *
MM
/
DD
/
YYYY
How many volunteers participated? *
How many trash bags did you collect? *
Where are the trash bags located? *
Are the trash bags another color other than the Adopt-A-Highway branded bags? *
Is there any bulk items, hazardous materials, or dead animals that need to be picked up by our crews? Please leave them in place and specify the location.  Is it located with the trash bags or elsewhere on the segment? *
Preferred contact method *
Required
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