Trash Survey - People for Portland

First Name*

Last Name*

Phone

Email

Street Address City State / Province / Region ZIP / Postal Code

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How is your owned or rented property being impacted by the accumulation of trash on city or state property?

In proximity to your owned or rented property, where is the accumulation of trash on city or state property? If there is no specific street address, please give cross streets.

Have you had to spend money to address the effects of the accumulation of trash on city or state property. For example, have you spent money on rodent/pest control or hazardous waste clean-up?*

Yes

No

If yes, please describe:

Have you been otherwise financially impacted by the trash accumulated nearby on city or state property?*

Yes

No

If yes, please describe:

GFI Tracking: Basic Data

Origin URL Page Title Source URL Query String Full URL Date Time

GFI Tracking: UTM Data

UTM Source UTM Medium UTM Campaign UTM Content

GF Iterable: Workflows

Workflows

Comments

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