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2. Group Name
4. County Highway (CH) Number
6. To/From Location
   Example: CH 2 to CH 8
8. Location of Bags
   Example: Single or Multiple locations
10. Submitted By
12. Name
13. Email Address
15. Address
17. City
18. State
19. Zip Code
21. Phone Number
22. Fax Number
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25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

* indicates a required field