Adopt-A-Road Cleanup Notification and Supplies Request

Spokesperson Name *

First Name

Last Name

Spokesperson Phone Number *

(###)

###

####

Tentative Date of Cleanup *

MM

DD

YYYY

Support Needed *

Trash Bags

Gloves

Safety Vest

Litter Grabbers/Pickers

Traffic Safety Road Signs

How will you dispose of the trash? *

We will bring the bags to a Knox County Convenience Center or dispose of myself

Please have the Knox County Litter Crew or City of Knoxville Public Service come get the bags from the stretch of road we clean. (Group must verify when cleanup is completed)