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DIAMOND BAR
C A L 1 F 0 R Pi t A.
City lyia nager° s Office
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218-10 Copley Drive
(909) 839 n 01-5
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SI3 1383 ORGANICS RECYCLING REGULATIONS
WAIVER REQUEST FORM
APPLICANT INFORMATION
BUSINESS O MULTI -FAMILY COMPLEX NAME
BUSINESS LICENSE NUMBER
BUSINESS OR MU TL I -FAMILY PHYSICAL ADDRESS
DATE SUBMITT D
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BUSINESS OFFICE MAILING ADDRESS CITY
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STATE ZIP
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CONTACT INFORMATION (for designated business representative who should receive waiver related notices from the City)
Contact NamefTitle Phone Number E-Mail
Ol�IG- �af t
WAIVER TYPE (Check the ..adjacent.-
and answers to aft 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 TTWrd-Party Recycling Waiver
• Third -party organic waste recycling service info ation:
➢ Recycler(s):1) Business Li #: Self -Haul Permit #: Phone:
2) _ _ Business tic #: 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)
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Please provide the following information to request a low -waste generator "de minimis" waiver:
• Average number of employees onsite:
• Does yotir business have a cafeteria providing meals to employees?
• Estimated number of employees that eat meals/snacks onsite:
• Contracted landscaper service informat'�°�
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➢ Landscaper name: _A _ Business License #:
Self -Haul Permit #: Phone:
• Average amount of organic waste collected per week:
n z 2 cubic yards of waste and < 20 gallons of organics
Q< 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 sr)ace 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 Food waste recycling only 0 Green waste & food waste
By signing this form, you are attesting that you have a full understanding of your business'/property's obligations to provide information,
report to, and otherwise fully cooperate wit the City as detailed in the instructions herein which accompany this form.
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Printed Name, Title and Signat re of Authorized Business Representative Date