COMMERCIAL TOWNSHIP
CLEAN-UP FORM
ADOPT-A-ROAD PROGRAM
NAME OF
ORGANIZATION________________________________________
NAME OF CLEAN
COMMUNITIES GROUP LEADER_________________
PHONE NUMBER OF GROUP
LEADER_____________________________
NAME OF ROAD CLEANED________________________________________
DATE OF
CLEAN-UP______________________________________________
NUMBER OF HOURS OF
CLEAN-UP________________________________
NUMBER OF BAGS OF
TRASH_____________________________________
NUMBER OF BAGS OF
RECYCLABLES_____________________________
NUMBER OF
TIRES________________________________________________
APPROX. NUMBER OF MILES
OF ROAD CLEANED__________________
NUMBER OF PARTICIPANTS
IN GROUP____________________________
NUMBER OF PARTICIPANTS
AT THIS CLEAN-UP___________________
PLEASE HAVE EACH MEMBER PRINT HIS/ HER
NAME ON THE BACK OF
THIS FORM TO USE AS YOUR SIGN IN SHEET.
THANK YOU FOR YOUR COOPERATION WITH ALL
OF THE ADDITIONAL INFORMATION. THE
CLEAN COMMUNITIES PROGRAM HAS NEW GUIDELINES WHICH MUST BE FOLLWED IN ORDER TO
CONTINUE TO RECEIVE THE GRANT.
PLEASE
RETURN THIS FORM TO:
COMMERCIAL
TWP. CLEAN COMMUNITIES COORDINATOR
ATTN:
JEANNE HITCHNER
1768
MAIN STREET
PORT
NORRIS, NJ 08349
FAX:
(856) 785-9420
PLEASE
CALL WITH QUESTIONS OR CONCERNS
(856)
785-3100, EXT. 310