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2. Entity Name*
4. Owner Name*
6. Mailing Address*
8. Physical Address*
10. Contact Name*
11. E-mail*
15. Does your organization dispose of four (4) or more cubic yards of waste per week?

    1. Yes
    2. No
16. Is your facility a multi-family dwelling of five or more (5+) units?*

    1. Yes
    2. No
20. Which materials do you currently recycle at your place of business? (Check all that apply)

    1. Clothing and/or textiles
    2. CRV containers (labeled "CRV" or "CA Cash Refund")
    3. Glass (Containers or Other)
    4. Metal
    5. Appliances

    1. Scrap Metal
    2. Non CRV-Containers
    3. Paper Fiber
    4. Cardboard
    5. Newspaper

    1. Wood Pallets/lumber
    2. Other
    3. Mail/Junk mail
    4. Office Paper

    1. Plastics (containers or Shrink wrap/film)
    2. Styrofoam/ Other foam material
    3. Tires
    4. None
22. If other was selected, please explain below.
26. The recycled material are ...*

    1. Source separated (separated by material type)
    2. Comingled (organic materials are mixed together)
27. The organics are composted through

    1. On-site composting
    2. Self-haul from my facility to a compost facility
    3. Landscaper/contractor
    4. Service provider/hauler
29. Amount recycled:

    1. Tons (Enter on the right)
    2. Pounds (Enter on the right)
    3. Monthly
    4. Yearly
30. Tons
31. Pounds
35. Which organics do you currently separate for composting?

    1. Grass/plant trimmings
    2. Soiled paper products
    3. Wood waste/chipping
    4. Food waste
    5. None
36. The organics are composted through:

    1. On-site composting
    2. Self-haul from my facility to a compost facility
    3. Landscaper/contractor
    4. Service provider/hauler
40. Signer certifies that they are a duly authorized representative of the above named entity for purposes of regulatory compliance reporting and that the foregoing is true and correct to the best of their knowledge.
42. Signature:*
    Type in name to acknowledging statement above.
43. Date:*
45. This information will be used to determine compliance with AB341 and may be reported to the State of California. For questions or concerns, please email Xavier Guluarte at xguluarte@ci.patterson.ca.us or visit www.ci.patterson.ca.us/564/Mandatory-Commercial-Recycling
47. Additional Information about California's Mandatory Commercial Recycling legislation can be found by visiting the California Department of Recycling Resources and Recovery's webpage at: http://www.calrecycle.ca.gov/Recycle/Commercial/
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49. 1. Receive an email copy of this form.
50. Email address

    This field is not part of the form submission.

51. Submit

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