AB 341: Mandatory Commercial Recycling (Plastics, Metal, Glass, etc.) Waiver

2. Modesto Business Name*
3. Contact Name*
4. Email Address*
5. Phone Number*
7. Street Address*
9. City*
10. State*
    -- Select One --AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
11. Zip Code*
13. Who is your waste hauling company?*
    -- Select One --GiltonBertolotti
17. Please mark the materials you currently recycle at your place of business below.

    Remember all of the following items are considered Hazardous Waste and must be diverted from landfills and therefore cannot be placed in your garbage cans. They must be recycled or taken to a Household Hazardous Waste Facility.

    1. Light Bulbs
    2. Ink jet/Toner Cartridges
    3. Batteries
    4. Paint
    5. Universal
    6. Electronic
    7. Household Hazardous Waste
19. Does your business currently have any type of recycling in place?

    1. Yes

    1. No

    1. Not Sure
21. Hazardous Waste Items

    Remember all of the following items are considered Hazardous Waste and must be diverted from landfills and therefore cannot be placed in your garbage cans. They must be recycled or taken to a Household Hazardous Waste Facility.

23. CRV Containers (Check all that Apply)

    1. Plastic

    1. Glass

    1. Aluminum
25. Paper Fiber (Check all that Apply)*

    1. Cardboard

    1. Newspaper

    1. Junk Mail

    1. Office Paper
27. Metal (Check all that Apply)

    1. Appliances

    1. Scrap Metal

    1. Non-CRV containers
29. Wood (Check all that Apply)

    1. Wood Pallets

    1. Non-treated lumber
31. How are your Recycling materials processed?

    1. Source separated by material type
    2. Comingled
33. How are your Recycling materials transported?

    1. Self-hauled for recycling
    2. Service provider/hauler
    3. Non-profit organization for donation
35. Acknowledgement

    Since July 1, 2012, businesses have been required to recycle. If you need assistance in complying with this law, please contact Vicki Rice, Recycling Program Coordinator with the City of Modesto at (209) 577-5495 within 30 days of receipt of this letter to request assistance in developing your program. Our goal is 100% compliance and we are here to provide information and guidance.

    1. I understand that this is a state law, and that if I need assistance in complying, I should contact the City of Modesto to request assistance.
37. Signature of Authorized Representative

    Type your name to sign.

38. Title*
39. Date*
    Date
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41. 1. Receive an email copy of this form.
42. Email address

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43. Submit

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