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City of Elk Grove Telephone: 916.627.3452 8401 Laguna Palms Way Fax: 916.691.3173 Elk Grove, California 95758 www.egtrashreycleservices.org

Business and Multifamily Recycling Plan Information on this report will not be disclosed except as required under the law.

__ Other:

6. Number of Employees/Tenants: Square Footage/No. of Units: 7. I am aware that Chapter 30.60 of the Elk Grove Municipal Code requires my business or

multifamily property to implement a Recycling Program as follows. My business or multifamily property:

a. Has Reviewed the list of “Designated Recyclable Materials”

included as Exhibit A to this form Initial

b. Is separating designated recyclable materials from garbage. Initial

c. Is displaying signs and labeled containers in appropriate areas or rental units for the collection of designated recyclable materials. Initial

d. Is a party to a written service agreement for recycling collection service or has completed a self-haul recycling form. (Self-haul form must be on file at the place of business and available for inspection or request by the City of Elk Grove.) Initial

e. Is receiving the following level of collection service for designated recyclable materials:

Container size: 96 gallons, 1 yard, 3 yards, other Frequency: Weekly/bi-weekly/other Indicate recycling collector(s):

1. Business/Generator Name: 2. Contact Name: Phone Number: 3. Address: 4. Hauler: Hauler Account Number: 5. Business Type:

__ Office __ Food Service __ Retail __ Industrial/Warehouse

__ Multifamily __ Hotel __ Church __ Medical

__ Auto __ Service/Gas

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f. OR, I decline to comply at this time, and I understand that I am in violation of Chapter 30.60 of the Elk Grove Municipal Code and could be subject to fines and penalties.

Initial 8. Blue recycle bin: Offered Requested/provided Waived 9. Please check the box for how you will comply with recycling each designated recyclable material:

Designated Recyclable Materials Waste Hauler Authorized

Recycler Self-Haul

Exempt/ Don’t Generate

Aluminum and Steel Containers

Food Waste

Glass Bottles and Containers

Green Waste

Mixed Paper (newspaper, junk mail, cardboard, phonebooks, magazines, computer paper, milk and egg cartons)

Plastics (all empty food and beverage containers #1-#7)

Scrap Metal

Wood Pallets

10. SIGNATURES: I understand and confirm that this information is true and correct.

Business Representative: Hauler District Manager:

Print Name Print Name Signature Signature Date Date