Thank you for taking the time to complete this form to let us know about a Union County road that has been littered.
Date of complaint:
-- mm/dd/yy
Please provide the following contact information:
First Name Last Name Work Phone Home Phone E-mail
Where is the littered location? Street Address Address (cont.) City Is the littered area near a natural water resource such as a creek, lake, river, etc.? yes or no
Is the littered area near a natural water resource such as a creek, lake, river, etc.?
yes or no
How would you rate your opinion of the severity of the litter? Mark only one number on the scale below. One ranks the lowest (small amount of litter), and five ranks the highest (largest amount of litter).
1 2 3 4 5
Describe the type of litter, such as general trash, tires, building materials, etc.