HomeMy WebLinkAboutWaiver Application- Life Medical Group.pdfCity Manager's Office
Attn: Tara Reyes
21810 Copley Drive
Diamond Bar, CA. 91765 CIT5.~ (909} 839·7015
greendb@diamondbarca.govDIAMOND BAR
CALIFORNIA
S8 1383 ORGANICS RECYCLING REGULATIONS
WAIVER REQUEST FORM
D 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:
> Recyc/er(s):1) Business Uc #: Self-Haul Permit #: Phone: _
2) Business Uc #: Self-Haul Permit #: Phone: _
> Material type(s): Est. recycled per week: __gallons OR cubic yards
> Fecilit(ies) where this material is taken for recycling
[l]WAIVER FOR BUSINESSESIPROPERTIES 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: 3-4 (M. Tu. W)
• Does your business have a cafeteria proViding meals to employees? _N_O _
• Estimated number at employees that eat meals/snacks onsite: 3 (M.Tu.W)
• Contracted landscaper service information:
> Landscaper name: Business License #: _
Self-Haul Permit #: Phone: _
• Average amount of organic waste collected per week:
D <: 2 cubic yards of waste and < 20 gallons of organics
[l]< 2 cubic yards of waste and < 10 gallons of organics
D SPACE CONSTRAINT WAIVER
Please provide the following information to request a Space Constraint Waiver.
• I have documentation thatsoace 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....N",o,-_
• Please indicate the specific program(s) you are requesting a waiver for:
Green waste recycling only.D Food waste recycling only.D Green waste & food waste .D
Oate
10-9+-2024
By signing thls form, you are attesting at you have a full understanding at your business'/property's obligations to provide information,
report to, and otherwise fully coope t with the City, as detailed in the instructions herein which accompany this form.
Printed Name, TiDe and Signature of A
Hye Kim, Manager