City & County of Honolulu Department of Environmental Services

Adopt-A-Stream / Adopt-A-Block Notification Form

Please complete and submit prior to cleanup.

Name of Group/Organization:
Contact Person:
Email:
Date of Cleanup:
Time:
Number of Volunteers:
Total Number of Participants:	Youths Adults
Who will supervise the project?
Drop off and pick up point of contact and street address:

Properly secure and completely tie all bags. Separate burnable and recyclables (e.g. tires, batteries, metals, plastic bottles, aluminum cans, etc.) Group the bags together and indicate the location for waste collection and disposal. Please do not block sidewalks.

Submit Adopt-A-Stream / Adopt-A-Block Notification Form. Please allow a minimum of two weeks processing time.