De Minimis Waiver Application

GRANADA COMMUNITY SERVICES DISTRICT ORGANICS COLLECTION SERVICE – DE MINIMIS WAIVER APPLICATION

Type of Application: (required)

New Application

Renewal

Appeal

Date (required)

BUSINESS OR MULTI-FAMILY COMPLEX NAME (required)

BUSINESS OR MULTI-FAMILY PHYSICAL ADDRESS (City, State, Zip) (required)

BUSINESS OFFICE MAILING ADDRESS (City, State, Zip)

CONTACT INFORMATION (for designated business representative who should receive waiver related notices from GCSD)

Contact Name/Title (required)

Phone Number (required)

Email (required)

• Average amount of organic waste collected per week: (required)

Less than 2 cubic yards of waste & generate no more than 10 gal. of compostable waste per week

2 or more cubic yards of waste & generate no more than 20 gal of compostable waste per week.

Photo verification and/or supporting documentation:

Customer Attestation (required)

By typing my name below, I certify that all the information presented in this application is correct and assume responsibility to notify GCSD and my hauler of any changes. I understand that this waiver expires 5 years from the approval date and accept that it is my responsibility to apply for a waiver renewal 30 days prior to the expiration date. Failure to renew a waiver prior to the expiration date does not waive any penalties or fines for noncompliance that may be incurred

Signature of person submitting application: (required)

Date: (required)

Name of person submitting this application: (required)

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