Fillable Cleanup Report Form-Pataskalapdf

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Cleanup Report Form-Pataskalapdf

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Adopt - A - Street Program For the City of
Pataskala Informational Sheet on Cleanup Date
Group or Organization:
Contact Person:
Phone Number:
Email Address:
Location of Clean Up:
Supplies Given Out
# Of Trash Grabbers:
Trash Bags: Gloves: Vests:
Date of Clean Up:
Number of People:
Hours Volunteered:
# of Bags Collected:
Please give a 48 notice before your planned cleanup date
After your cleanup please email your report to:
Email: jcumbo@ci.pataskala.oh.us
Phone # : 740-927-2021
Fax #: 740-927-0228
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Cleanup Report Form-Pataskalapdf

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Completed 12 July 2020

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