Adopt-A-Street and Adopt-A-Drain Programs

Adopt-A-Street and Adopt-A-Drain Programs Seattle Public Utilities 700 5th Avenue, Suite 4900 PO Box 34018 Seattle, WA 98124-4018

Supply Request Form

Follow these three steps to request supplies for your Adopt-A-Street or Adopt-A-Drain cleanup event! Please complete and submit your supply request at least two weeks prior to your scheduled event to allow time to fill your order.

Note: It is the sole responsibility of the Adopt-A-Street and/or Adopt-A-Drain volunteer to arrange for the return of supplies to the City of Seattle’s Adopt-A-Street and/or Adopt-A-Drain programs. Possession of City government property beyond agreed-upon terms is unlawful.

Please print clearly and legibly. Step 1. List Contact Information for the Cleanup Event Organizer

Adopt-A-Street volunteer? Adopt-A-Drain volunteer? First and last name: Name of volunteer group or organization: Phone number: Email address: Today’s date: Date of cleanup event:

Step 2. Indicate Exact Number of Supplies You Need

PLEASE DISPOSE OF THE FOLLOWING ITEMS AFTER USE: How many of each? Canvas gloves: (We cannot accept used gloves, so please reuse Rubber gloves: (We cannot accept used gloves, so please reuse them.) them.) Small Large Small Medium Large Ex. Lg. Plastic garbage bags: Compostable paper bags: (Dispose of non-recyclable and non-compostable litter.) (Dispose of compostable street debris and leaves.) Sharps containers: (Limit one per volunteer group.) Note: Sharps containers must be disposed of at the City’s Recycling& Disposal Stations are located at 1350 N 34th St and 8105 5th Ave S.

PLEASE RETURN THE FOLLOWING ITEMS AFTER USE: Litter grabbers: Dustpans: Safety vests: (Limit one per volunteer group.)

FOR ADOPT A DRAIN VOLUNTEERS ONLY: Rakes: Shovels: Storm drain stencil kit: Brooms: Small Regular (Limit one per volunteer group.)

Step 3. Report Every Cleanup Even if you do not require a litter pick-up, always report your cleanup event once it has ended by calling the hotline at 206- 684-7647 or sending us an email at the address listed below. Let us know the following:

 Your name and phone number  Number of volunteers who participated  Name of your organization  Number of bags  Number of hours spent on the cleanup For Office Use Only Date and time of supply pick-up: Date and time of supply drop-off: Signed: Adopt-A-Street and Adopt-A-Drain Programs Seattle Public Utilities 700 5th Avenue, Suite 4900 PO Box 34018 Seattle, WA 98124-4018  The location of the bags, if you have two or more full bags to be picked up.

Return completed form to [email protected] or [email protected], or fax to 206-684-8529. Questions? Call the Adopt-A-Street/Adopt-A-Drain Hotline at 206-684-7647. http://www.seattle.gov/util/Services/Garbage/KeepSeattleClean/Adopt-A-Street/index.asp

For Office Use Only Date and time of supply pick-up: Date and time of supply drop-off: Signed: