Commercial Bin and Cart Request - New Customer

Commercial Bin and Cart Request - New Customer Requested delivery date: Account Number: Customer Name: SITE ADDRESS: Street City State, Zip Code Phone Number Email BIN COLLECTION SERVICE - 1YD - 8YD (Please check appropriate box.): c Commercial Garbage Service - Bin size To be serviced time(s) a week c Mixed Recyclables Service - Bin size To be serviced time(s) a week c Organics (food/yard waste) Service - Bin size To be serviced time(s) a week CART COLLECTION SERVICE - 32 GALLON - 96 GALLON (check appropriate box): c Commercial Garbage Service - Cart size To be serviced time(s) a week c Mixed Recyclables Service - Cart size To be serviced time(s) a week c Organics (food/yard waste) Service - Cart size To be serviced time(s) a week Collection service must be provided at least weekly. Note that recyclables and organics collection service will be provided for no additional charge to commercial customers with adequate garbage service. Basic service includes weekly service of up to 96-gallons of recyclables and up to 96-gallons of organics free of charge. Additional carts, larger recyclable bins and up to five days of collection are available for a charge. Please note that recycling is mandatory in Alameda County. If recyclables and organics service is not already in place, we invite you to contact us today and get started. Deposit equal to one month s service is required AND IS NOT BILLABLE. This is required for each bin depending upon amount of service. Deposit is refundable when account is closed and balance paid. We accept company check, money order, credit card (VISA, MasterCard & Discover) or cash (no third-party checks). 1

Commercial Bin and Cart Request IF THE DRIVER DOES NOT HAVE DIRECT ACCESS TO YOUR COMMERICIAL BIN, PLEASE FILL IN THIS REQUIRED INFORMATION: c PUSH/PULL* This includes bringing the container to the curb and returning the container back to your property. LINEAR FEET (Distance from location that driver will dump bin to location where bin is stored). c PUSH* This includes bringing the container to the curb after servicing. LINEAR FEET (Distance from location that driver will dump bin to location where bin is stored). c PULL* This includes returning the container from the curb to your property after servicing. LINEAR FEET (Distance from location that driver will dump bin to location where bin is stored). * PLEASE SEE ATTACHED RATE SHEET FOR FEES ON ABOVE SERVICES. NOTE THAT PUSH/PULL DISTANCE WILL BE VERIFIED BY AN ACI SUPERVISOR. 2

Commercial Bin and Cart Request SERVICE NOTES: Make sure container is accessible by 5am on scheduled service day. Do not block container with parked vehicle(s) or other obstacles. Provide gate key or code if container is located behind locked gate. If for any reason the garbage, recycling or organics container is not picked up on the regularly scheduled day, please call our office no later than 7:00am the next business day so we can return to service the container. Put materials in the appropriate container for collection. ACI will not pick up loose or misplaced materials. DO NOT DISPOSE OF HAZARDOUS WASTE IN CONTAINER. Do not place mattresses or box springs in containers. Do not place wooden pallets in containers. Do not place more than 400 pounds in one-yard containers. Level off the materials inside containers to assure service. Service cancellations or modifications must be made in writing either by mail, fax, email or in person. Verbal cancellations will not be accepted. Cancellations will not be made retroactively. It is the customer s responsibility to end services with Alameda County Industries and all services are due and payable until proper paperwork is submitted. If you have any questions regarding the service, please call our office at 510-483-1400. COMPLETED FORMS CAN BE: emailed to: info@alamedacountyindustries.com faxed to: 510-814-7314 mailed or hand-delivered to: Alameda County Industries, Thank you, Alameda County Industries Customer Initials Please print and keep a copy of this page for your records July 2015 3

Liability Waiver In consideration of the agreement of Alameda County Industries and/or its affiliates ( ACI ) to enter onto the premises of the undersigned described below with ACI s vehicles and equipment to collect garbage and/or recyclable materials, the undersigned does hereby agree to forever release and save harmless ACI and its shareholders, officers, directors, agents, affiliates, insurers and successors from and against any and all claims, damages, actions, causes of action, costs and expenses (including attorney s fees) relating to damage to pavement or driving surfaces on such premises which may arise in any manner out of or in connection with the entry or operation on, or egress from, such premises by ACI s vehicles and equipment. The undersigned also acknowledges, and waives to the maximum extent permitted by law any rights or benefits the undersigned may have under, Section 1542 of the California Civil Code, which provides as follows: A general release does not extend to claims which the creditor does not know or suspect to exist in his or her favor at the time of executing the release, which if known by him or her must have materially affected his or her settlement with the debtor. Name: Title: SITE Address (where container will be located): Street City State, Zip Code Signed: Dated: Customers are required to complete this credit application only once for life of their ACI account. 4

Credit Application* Account# (to be completed by ACI representative) Company/Owner Name: SERVICE ADDRESS: Street City State, Zip Code BILLING ADDRESS: Street City State, Zip Code Please supply at least one phone number: Phone Fax Cell phone Email Address Phone Fax Cell phone Email Address TYPE OF ENTITY (please check one): c Corporate c Sole Proprietor/Owner c Partnership *Please note that ACI does not run your credit report. Customers are required to complete this credit application only once for life of their ACI account. 5

Hazardous Waste Policy Notice Dear Customer: The enclosed documents need your immediate attention due to increasing requirements by State and Federal agencies to properly dispose of potentially hazardous waste. The waste generator (Customer) has been identified as the responsible party in determining liabilities for the improper disposal of potentially hazardous waste. Since we do not manage waste that is hazardous, we need your assistance in the identification of potentially hazardous waste. Please complete the enclosed Waste Survey sheet. WE WILL NOT BE ABLE TO START YOUR SERVICE UNTIL IT IS RECEIVED. Thank you for your cooperation. Any questions please contact us at 510-483-1400. Thank You, Alameda County Industries 6

City of Alameda - Waste Survey Sheet YOU CANNOT DISPOSE OF ANY HAZARDOUS MATERIALS IN ANY OF ALAMEDA COUNTY INDUSTRIES CONTAINERS. 1. What products does your company manufacture? 2. Are you currently disposing of any waste listed below? Yes No Waste c c Drums, barrels, pails, etc. c c Bulk containerized transported waste c c Liquid waste c c Sludge Waste c c Industrial process waste c c Pollution control waste c c Residue from clean up of a spill c c Contaminated soil or other items from a clean-up of a special waste, disposal, treatment, recycling site. c c Chemical laboratory waste c c Poly-chlorinated by phenyl (PCB) contaminated articles equipment and/or clothing c c Asbestos c c Commercial products or chemical that are outdated, contaminate or banned c c Infectious or pathological waste from hospitals, medical practitioner, Veterinary clinic. c c Parts from slaughter house or rendering plant c c Fruit, vegetable grain processing waste c c Septic tank pumping c c Sewage sludge c c Grease trap waste from restaurants and residences c c Car wash/laundromat wash water c c Batteries, fluorescent tubes, Cathode Ray (TV) c c Contaminated dismantled industrial process equipment c c Closed cartridge filter from dry cleaning establishments c c Animal waste c None of the above 3. How has the waste been disposed of until today? Name Title Date Company Name Signature 7

City of Alameda - Commercial Cart and Bin Rates 8