Waste Delivery Form
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1Waste Delivery Form
(800) 606-6606
Participant name _____________________________________________________________
Do you have any:
Street address _______________________________________________________________
q
Sharps
q
Medical waste
City __________________________________ Zip _________________________________
(we cannot accept controlled
Telephone: (________) ____________________ No. of households represented: _________
substances)
Declaration of origin:
I hereby certify that the following waste was generated in Alameda County, through household use:
Signature: ____________________________________________ Date: _________________
Packaging Instructions
• No individual item or container may be greater than 5 gallons or 50 pounds in size.
• All materials must be packaged in sturdy, non-leaking, closed containers. If you have a leaking container, place it in a larger
container (such as a plastic bucket available from paint stores); include the original label or a note with as much information
as possible about the material and its ingredients.
• Do not mix different wastes in the same container
• Place the materials upright in your vehicle; for safety, we recommend placing materials in boxes in your vehicle’s trunk. Pack
the materials so they will not slide, tip over, spill or break during transport
Limits
• State Regulations limit the amount of waste you may transport to 15 gallons” of liquid waste, or 125 lbs solid waste.
Individual items/containers must be no larger than 5 gallons or weigh no more than 50 lbs.
*15 gallons refers to the actual contents of the containers, not the container size.
Please help us understand our customers better by answering the following questions:
q
q
What kind of home do you live in?
Single Family home
Apartment/Condo in a 2-4 unit building/complex
q
q
Apartment/Condo in a 5+ unit building/complex
Other: please describe: __________________
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q
Do you:
Rent or
Own your residence?
Do you have any comments or suggestions to improve our service? ____________________________________________________
____________________________________________________________________________________________________________
SHADED AREA FOR STAFF USE ONLY
q
q
q
q
q
q
q
Min
S
M
L
XL
XXL
E-Waste
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q
q
Received by: _______________________________________
ID checked
Sharps
Med Waste
q
q
q
Date: ________________________________ Time: _____________________
Hay
Oak
Liv
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Parent category: Legal