HomeMy WebLinkAboutWaiver_Application-River_of_Life_Community_Church.pdfC I T Y Q F
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DIAMOND11
City Manager's Office
Attn: Alfa Lopez
21810 Copley thrive
Diamond Bar, CA. 91765
(909) 839-7015
gre(.-tidb@dlanioiidbarca.gov
SB 1383 ORGANICS RECYCLING REGULATIONS
WAIVER REQUEST FORM
APPLICANT INFORMATION
BUSINESS OR MOLT -FAMILY COMPLEX NAME BUSINESS LICENSE NUMBER .
BUS INE S OR MULTI -FAMILY PHYSICAL ADDRE S DATE SUBMITTED
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BUSINESS OFFIC2 MAILING ADDRESS.:
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ZIP
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CONTACT. INFORMATION (for designated business representative who should receive waiver related notices from the. City)....
..:Contact Name/Tltle Phane Number E-Mail
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CIS (-�s,� C
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WAIVERTYPE
and. .. . nt to the exemption waiver type(s) you are requesting below andprGvide information
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):9) 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 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: z
• Does your business have a cafeteria providing meals to employees? L\\"
• Estimated number of employees that eat meals/snacks onsite:
• Contracted landscaper s7 ce if formation: �+
➢ Landscaper name: Cc lG Vim J t.�i I °Cs�_ Business License #:
Self -Haul Permit #: Phone: &0
• Average amount of organic waste collected per week:
Q a 2 cubic yards of waste and < 20 gallons of organics
< 2 cubic yards of waste and < 90 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
s 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 with the City, as detailed in the instructions herein which accompany this form.
Printed Name, Title and Signature of Authorized Business Representative
Date