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Earth Day Litter Clean Up Supplies Request

2. Earth Day Litter Clean Up
   Help celebrate the 50th anniversary of Earth Day on April 22nd! We are encouraging schools and businesses to pick up litter around their property.

   Help celebrate the 50th anniversary of Earth Day on April 22nd! We are encouraging schools and businesses to pick up litter around their property.

4. Clean Up Results - Reporting Form
   We ask that you please track the number of volunteers, hours worked and number of filled trash bags collected by filling out the provided reporting form.

   We ask that you please track the number of volunteers, hours worked and number of filled trash bags collected by filling out the provided reporting form.

6. Questions?
   Please contact Danielle Semsrott, Senior Planner at dsemsrott@bentonvillear.com or (479) 271-6827.

   Please contact Danielle Semsrott, Senior Planner at dsemsrott@bentonvillear.com or (479) 271-6827.

8. Contact Information

10. Name

12. Location

    Please list the place of business or school name and address.

14. Email Address

15. Phone Number

17. Supplies
    Supplies may be picked up starting Monday, April 21st, and extra supplies returned at your convenience to the City's Community Development Building located at 305 SW A Street, 2nd floor. Hours are M - F, 8:00 a.m. to 4:30 p.m.

    Supplies may be picked up starting Monday, April 21st, and extra supplies returned at your convenience to the City's Community Development Building located at 305 SW A Street, 2nd floor. Hours are M - F, 8:00 a.m. to 4:30 p.m.

19. Approximate number of adult volunteers) over 18

20. Approximate number of youth volunteers (under 18)

22. Supplies

    Please select the supplies you will need:

    1. Trash bags
    2. Safety vets (S/M)
    3. Safety vets (L/XL)
    4. Nitrile gloves
    5. Cloth gloves
    6. Litter grabbers (limited supply)*
    7. Bug spray
23. *Number of litter grabbers needed (if requested)

25. Litter Disposal

    Please indicate whether you prefer to dispose of the filled trash bags on your own or have city crew pick them up.

    1. Dispose on my own
    2. City crew pick them up*
27. *If under Litter Disposal above, you checked "city crew pick them up" , please indicate the location where filled trash bags will be left for city crew to pick up.

Leave This Blank:


29. 1. Receive an email copy of this form.
30. Email address

    This field is not part of the form submission.

31. Submit

* indicates a required field