Certification Application For Collection & Community Service Programs Form 2010 Page 2
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4OPERATOR INFORMATION
(Continued)
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5)
Are you or this program currently certified by CalRecycle, Division of Recycling, in any category? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
If YES, Certification Number(s) ________________________________________________________________________________________________________
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6)
Were you or this program previously certified by CalRecycle, Division of Recycling, in any category? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
If YES, Certification Number(s) ________________________________________________________________________________________________________
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Do you or this program have other applications pending with CalRecycle, Division of Recycling, in any category? . . . . . . . . . . . . . . . . . . . . . . .
7)
Yes
No
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8)
Have you or this program ever been denied certification by CalRecycle, Division of Recycling, in any category? . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
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9)
Do you speak English? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
If No, which language is spoken? ______________________________________________________________________________________________________
PROGRAM DESCRIPTION
10) Program Name _______________________________________________________________________________________________________
11) What types of empty beverage containers do you collect or accept?
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Aluminum
Glass
Plastic
Bimetal
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12) Are you applying as a Neighborhood Dropoff Program?
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Yes
No
If yes, submit a copy of a letter of authorization from city, county, or city and county specifying the dropoff locations, and a regional map outlining the
geographical area served.
List the address of the dropoff location(s) served under the neighborhood dropoff program
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____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
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13) Do you have an established (or regular) route you follow to collect empty beverage containers?
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Yes
No
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14) Do you have a regular schedule for collecting empty beverage containers?
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Yes
No
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15) Do you collect empty beverage containers directly from bars, restaurants, hotels and motels?
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Yes
No
If yes, please list the name, address, phone and contact person for three of any of the following: bars, restaurants, hotels an d motels where you collect.
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16) Do you collect empty beverage containers directly from office buildings, industrial/commercial buildings?
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Yes
No
If yes, please list the name, address, phone and contact person for three of any of the following: office buildings, industrial/commercial buildings where you
collect.
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17) Where else do you collect empty beverage containers?
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Streets/Alleys
Apartment Complexes
Parks/Recreation Areas
Parking Lots
Residential Garbage
Transfer Station
Landfill Disposal Site
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Material Recovery Facility (MRF)
Special Events
Other (explain): ________________________________________________________
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