HomeMy WebLinkAboutDUPLICATEDeMinimisWaiverApproval-Prospectors_FCU.pdfCITY OF
DIAMOND BAR
L I BAR
H N I A
City Manager's Office
Attn: Alfa Lopez
21810 Copley Drive
c Diamond Bar, CA. 91765
RECEIVED (909) 839-7015
greendb@diamondbarca.gov
0118M dRC d&!5JZECYCLING REGULATIONS
WAIVER REQUEST FORM
APPLICANT INFORMATION
S{NESS OR RMULTI-FAMILY OMPLE N E BUSINESS LICENSE NUMBER
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CONTACT INFORMA ON (for designated business representative who should receive waiver related notices from the City)
Contact Namol7ltle Phone Number E-Mail
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WAIVER TYPE (Check the box(vs) adjacent to the exemption waiver (ype(s) you are requesting below and provide informa in
and answers to all questions requested for each waiver choice.)
❑ THIRD -PARTY WAIVER (if you have a landscape contractor and/or other organics recycler)
Please provide the following information to request a Third -Party Recycling Waiver.•
• Third -party organic waste recycling service information:
➢ Recycler(s):1) Business Lic #: Self -Haul Permit #: Phone:
2) Business Lic #: Self -Haul Permit #: Phone:
➢ Material type(s): Est. recycled per week: gallons OR cubic yards
➢ Facilit(ies) where this material is taken for recycling
WAIVER FOR BUSINESSES/PROPERTIES WITH MINIMAL ORGANIC WASTE (De Minimis Waiver)
Please provide the following information to request a low -waste generator "de minimis" waiver.
• Average number of employees onsite: l 1
1
• Does your business have a cafeteria providing meals to employees?
• Estimated number of employees that eat meals/snacks onsite:
• Contracted landscaper service information:
➢ Landscaper name: Business License #:
Self -Haul Permit #: Phone:
• Average amount of organic waste collected per week:
0 ? 2 cubic yards of waste and < 20 gallons of organics
< 2 cubic yards of waste and < 10 gallons of organics
SPACE CONSTRAINT WAIVER
Please provide the following information to request a Space Constraint Waiver:
• I have documentation that space constraints preclude placement of green waste and/or food waste recycling
containers at my business. No (Please attach documentation)
• I have worked with the City to determine that we cannot adjust container sizes or make other such changes to
resolve the space constraint issue, No
• Please indicate the specific program(s) you are requesting a waiver for:
Green waste recycling only Z:2 Food waste recyciing only= Green waste & food waste 0
By signing this form, you are attesting that you have a full understanding of your businessYproperty's obligations to provide information,
report to, and otherwise fully cooperate with the Cit s e 4ed in the ln�FdQfiaQs herein which accompany this form.
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Date
Name, Title and Signature of Authorized Business Representative