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DCR - Virginia Department of Conservation and Recreation
STORMWATER MANAGEMENT

Virginia Adopt-a-Stream
Stream Cleanup Data Form

Cleanup Date
Stream Adopted
Adopting Organization
Name of Designated Representative
Representative Phone Number
Locality
Map location from county road map (if available)
Location of stream section cleaned *
Number of miles cleaned
Number of participants, Adult
Children
Number of trash bags collected
Type of trash collected in bags
List unbagged trash
Estimated weight of trash
Most unusual item found
Cleanup time (in hours)
Comments
    

If possible, please send a map designating the stretch of the waterway that you've adopted as an email attachment to: bonnie.phillips@dcr.virginia.gov, or in hard copy form to:

Department of Conservation and Recreation
Adopt-A-Stream Coordinator
203 Governor Street, Suite 406
Richmond, VA 23219

Fax: 804-371-0315

(DCR 199-025)(12/00)