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Adopt-A-Drain Field Data Sheet

Thank you for your dedication to the Adopt-A-Drain program!

Your name: *

Approximate address of your storm drain: *

Date of inspection/ clean out: *

Was this a... *

Storm drain conditions: *

Storm drain blockage (debris/ yard waste): *

Items removed from on or around the storm drain grate (do not attempt to remove items from inside the storm drain): *

Is there evidence of dumping (any fluids such as paint, oil, fuel or unusual odors in or around the drain) *

If yes, please complete the comment box noting what was seen/smelled.

What is your best estimation for the volume of waste you picked up (using the distributed 13-gallon trash bags for reference)? *

Please upload any before and/or after photos of the clean up if you took them. You could be featured on our social media!

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