Form Center

2. Date Requested:*
   Date Requested:

   Date Requested:
3. Department:*
4. Room/Floor Number:*
6. Contact Person:*
7. Telephone Number:*
9. Please indicate the RECYCABLE item(s) to be picked up:*

   1. Office Paper
   2. Cardboard
   3. Newspapers
   4. Electronics
   5. Other - Bottles/Cans
10. Select Appropriate Request:*

    1. First Request
    2. Second Request
    3. Third Request
12. Special Request(s)/Information:
16. FOR PUBLIC WORKS USE ONLY:
18. Date Request Received:
19. Time Request Received:
21. Landfill Staff Notified:
23. Special Instructions:
Leave This Blank:


25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit Submit and Print

* indicates a required field