Date *

MM

DD

YYYY

5-Gallon Bucket Amount *

Please select the closest amount from one half of a 5-gallon bucket up to three, 5-gallon buckets worth of trash.

0.5

1

1.5

2

2.5

3

Time Spent Collecting Trash *

Please select the closest amount from one half hour up to three hours

0.5

1

1.5

2

2.5

3