Commercial Bin and Cart Request - New LSI Customer Account# Customer Name: SITE ADDRESS: Street City State, Zip Code Phone Number Requested delivery date: Email BIN COLLECTION SERVICE - 1YD - 7YD (check appropriate box): c Commercial Garbage Service - Bin size To be serviced time(s) a week c 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 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 The Garbage rate includes weekly service of 96-gallons of Organics and 96-gallons of Recyclables. Adequate Garbage service is required. Customers can request less than 96-gallons of Organics and/or Recyclables service per week but the monthly Garbage rate will not be discounted. If more than 96-gallons of Organics/Recyclables service is needed, current rates apply. 1
Commerical Service Guidelines DEPOSIT OF ONE MONTH S SERVICE IS REQUIRED. A deposit is required for each bin. The amount of the required deposit varies according to the level of service. Deposit is refundable when account is closed. We accept company check, personal check, money order, credit card (VISA, MasterCard & Discover) or cash (no third- party checks). SERVICE NOTES: Container should be out and available for pickup by 4:00am the day of pickup. Please do not block container in with parked vehicles or leave the container behind a locked gate. If for any reason the garbage, recyclables or organics container is not picked up on the regularly scheduled day, please call our office no later than 7:00am the next day so we can return to service the container. DO NOT DISPOSE OF HAZARDOUS WASTE IN CONTAINER. Do not place mattresses or box springs in containers. Do not place wooden pallets in containers. We will not pick up any material that is not in the appropriate container. No more than 400 pounds in one-yard containers. 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 Livermore Sanitation, Inc. and all services are due and payable until proper paperwork is submitted. If you have any questions regarding the service, please call our office Monday through Friday 7:00a.m to 5:00p.m at (925) 449-7300. COMPLETED FORMS CAN BE: emailed to: customerservice@livermoresanitation.com faxed to: (925) 583-3596. mailed to: Livermore Sanitation, Inc., Thank you, Livermore Sanitation, Inc. 2
Credit Application Account# (to be completed by LSI 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 Customers are required to complete this credit application only once for life of their Livermore Sanitation account. 3
Liability Waiver In consideration of the agreement of Livermore Sanitation, Inc. and/or its affiliates ( LSI ) to enter onto the premises of the undersigned described below with LSI s vehicles and equipment to collect garbage, recyclable and/or organic materials, the undersigned does hereby agree to forever release and save harmless LSI 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 LSI 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: 4
Hazardous Waste Compliance 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 indetermining 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 (925) 449-7300. Thank You, Livermore Sanitation, Inc. 5
City of Livermore Waste Survey Sheet 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? YOU CANNOT DISPOSE OF ANY HAZARDOUS MATERIALS IN ANY OF LIVERMORE SANITATION S CONTAINERS. Name Title Date Company Name Signature 6
Construction & Demolition Survey Sheet Dear Customer, As part of our continuous efforts to provide you with excellent service and a better understanding of your individual needs, we ask that you please complete the following construction and demolition survey sheet. The City of Livermore Municipal Code Chapter 15.28 defines construction and demolition debris as: used or discarded materials (not including garbage) separated from garbage. or refuse at the site of generation and removed from the premises during construction, renovation or demolition. Projects are defined as: any activity involving construction, demolition or renovation, and which requires issuance of a building permit. Project also includes city-sponsored construction, demolition or renovation. Regulated Project means a construction or renovation project of $300,000 or more, or a demolition project whose total cost is $40,000 or more. 1. Is your project subject to the C&D Ordinance? c Yes c No 2. Do you have a permit with the City of Livermore? c Yes Permit # c No 3. Is your project s valuation amount $300,000 or more? c Yes c No 4. Is your project s demolition valuation amount $40,000 or more? c Yes c No 5. Describe your project: 7
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