Adopt a Road Productivity Report Clean Up Date Clean Up Date Required Field Date Adopted Road From To Number of Volunteers Number of hours worked Total man hours Number of bags filled Trash Disposed of By Group Trash Needs Picked Up By DOT Other miscellaneous trash removed Order SuppliesBags (boxes) Qty. Safety Vests Qty. Pick Up Sticks Qty. Report submitted by: Name Title Organization Day Phone Fax Email Names of Volunteers whoparticipated in this clean upMailing Address HoursWorked1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20