Cleanup Wrap-Up Report

Community Clean Up Program - Keep Horry County Beautiful

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* 1. Community Cleanup Organization Name:

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* 2. Name of Group Leader:

First Name

Last Name

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* 3. Contact Information:

Email Address

Phone Number

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* 4. Event Date and Start Time

Date / Time

Date

Time

AM/PM

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* 5. Where did your cleanup take place?

Location 1

Location 2

Location 3

Location 4

Location 5

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* 6. How many hours did your group spend cleaning?

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* 7. How many volunteers were in your group?

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* 8. How many bags of trash did your group pick up?

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* 9. How many bags of recyclables did your group pick up?

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* 10. How many miles of roadway did your group pick up?

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* 11. How many acres of park land did your group pick up?

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* 12. How many miles of rivers, waterways, and/or beaches did your group pick up?

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* 13. How many miles of trails (hike and/or bike) did your group clean?

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* 14. Did your group find any illegal dump sites? If so, where?

Location 1

Location 2

Location 3

Location 4

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* 15. I hereby confirm that upon submitting of this form all the information above has been provided with the best of my knowledge on the following date:

Certification of Wrap Up Report Submission

Date

Time

AM/PM