Group NameDateContact NamePhone #E-mailNumber of VolunteersStart TimeEnd TimeStream NameStart LocationEnd LocationPhysical Stream Data (check all that apply)

Water Appearanceclear
muddy
grey/black
green/algea
oily
foamy
scummy
otherIf other, please explain in the box provided below.

Water Appearance OtherStream Bottomrocky
sandy
silty
otherIf other, please explain in the box provided below.

Stream Bottom OtherStream Banklarge trees
small trees/brush
weeds/plants
rip-rap (rock)
exposed soil
otherIf other, please explain in the box provided below.

Stream Bank OtherOdornone
musky/organic
rotten eggs or sewage
chemical
gas/oil
otherIf other, please explain in the box provided below.

Odor OtherPlease describe condition and location of any existing or potential water pollution problems (severe bank erosion, clear/discolored discharge from any pipes, accumulation of grass clippings/leaves from yards, unstable and/or missing sanitary sewer line supports, etc.)

Final description and comments Stream Cleanup Data

Estimated Number of Pounds?

Amount of Trash/Debris collected:Estimated number of bags?Please, give a brief description of the type of trash or debris collect.Has the trash or debris been disposed of? If NO, please tell us the location(s)Yes
NoPlease, describe location of debris needing pickup.