Storm Drain Stenciling Report

First Name
Last Name
Organization
Address 1
Address 2
City
State
Country
Zip
Phone
E-mail

 

How many people participated in the activity?*

 

Adult:

 

Female:

 

African American:

 

Caucasian:

 

   

*This information will be used to help to fine tune a nondiscriminatory education outreach program.

 

Date of Stenciling:
Stenciling Location:
Number of Drains Stenciled:

Additional Comments





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