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2. 
3. Interested in winning a rain barrel?

   Fill out the survey and include your contact information below to be entered into a drawing to win a rain barrel and stand. A winner will be randomly selected and notified in April. Entrants MUST be a Pleasant Hill resident. 

   Learn more on what the City is doing to protect stormwater by visiting www.pleasanthilliowa.org/stormwater.

5. How important to you is water quality in creeks & streams?*

   1. Very Important
   2. Somewhat Important
   3. Not Important
7. Do you know where the rainwater flows to after entering a storm drain on your street?*

   1. Yes
   2. No
9. Do you know what watershed you live in?*

   1. Yes
   2. No
11. Where does your gutter downspouts drain into?*

    1. Sidewalks
    2. Driveway
    3. Yard

    1. Flowerbeds
    2. Underground
    3. Storage Tank
13. When you mow the grass or rake leaves, what do you do with the clippings or leaves?*

    1. Collect and put in yard waste bins or bags
    2. Leave clippings on grass or spread in the yard
    3. Dump them in the gutter or ditch

    1. Pile them into a compost area in the yard
    2. Other
15. If/when your family washes a vehicle at home, where does the dirty wash-water flow?*

    1. Onto the grass, dirt or gravel
    2. Onto the street or driveway

    1. It varies
    2. I don’t wash my vehicle at home
17. Do you have any native vegetation (big/small bluestem, pale purple coneflower, etc.) on your property?

    1. Yes
    2. No
19. If you have a dog, do you pick up their waste from sidewalks, streets and yards?*

    1. Yes
    2. No
    3. N/A
21. What are your favorite aquatic activities?*

    1. Swimming
    2. Fishing
    3. Canoeing

    1. Boating
    2. Other (list below)
23. List any additional favorite aquatic activities:
25. First Name*
26. Last Name*
28. Address1*
30. Address2
32. City*
33. State*
34. Zip*
36. Email*
37. Phone*
39. Comments

41. **Entrants must be Pleasant Hill residents to win.

    **City employees are not eligible to win.

    **Limit one application per household.

    
    

Leave This Blank:


43. 1. Receive an email copy of this form.
44. Email address

    This field is not part of the form submission.

45. Submit

* indicates a required field