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Name of Contact
Adopt a Block Location and #
Date of Clean Up (MM/DD/YYYY)
Number of volunteers
Total number of hours by all volunteers
(ex: 2 volunteers x 2 hours = 4 total hours)
Number of bags of trash collected
Number of bags of recycling collected
Rate the cleanliness of your block on a scale of 1-5 (1-no trash, 5-excessive trash)
Upload a photo of your project.
Any additional comments
Thank you for participating in the Adopt-a-Block program!
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