Debris Box Service Request - Milpitas Sanitation

PO#:

Customer / Contact Name: *

First

Last

Email *

Site Address: *

Address Line 1

City

State

Zip Code

Site phone number: *

Site email: *

Billing address: *

Address Line 1

City

State

Zip Code

Billing phone number: *

Billing email: *

Type of customer: *

Residential
Commercial

Company / Owner Name (for Commercial customers only):

Please choose service type:

Compactor Collection (Compactors are supplied by customer)
Debris Box Service

Please provide compactor size/capacity (Compactors are supplied by customer):

Requested Debris Box delivery date:

Debris box size: *

6-yard debris box - all materials (this size for clean dirt, rock, brick and cement/concrete only)
15-yard debris box
20-yard debris box
30-yard debris box
40-yard debris box
None - I am requesting compactor collection service

Click here for debris boxes dimensions.

Debris box material (choose all that apply): *

Garbage
Wood
Dirt (6-yard box only)
Construction & Demolition (C&D - excluding dirt, brick, rock and cement/concrete)
Cement/concrete - no rebar (6-yard box only)
Recyclables - mixed
Recyclables - single stream (metal and cardboard)
Yard waste/compostable (6-yard box size for dirt and rock)
None - I am requesting compactor collection service

If recyclables single stream is selected, please list type:

Note: No Hazardous Waste allowed in box/compactor. Material cannot be higher than the edge of the box. Do not overfill box. *

I acknowledge the above statement (please check box to continue).

Debris box/compactor location: *

Street (PLEASE NOTE: street placement requires an encroachment permit from the City of Milpitas - Contact the Engineering Department at (408) 586-3329 for more information.)
Driveway
Other

Please list address / placement / other details here:

All debris box customers will be required to pay a prepayment per box per pull. Prepayment is equal to the per full charge for the size/material debris box requested. Billing includes: A Placement Fee, Per Pull Charge, and Tonnage Charge for each pick up or attempt to pick up. If the container is not picked up within seven days, a demurrage charge will be applied each day until service is scheduled. (Fees are outlined in the Rates section). *

I acknowledge the above statement (please check box to continue).

I have read the Billing and Service Guidelines.

We will not be able to start your service until you acknowledge these guidelines. Billing includes: A per pull charge and tonnage charge for each pick up or attempt to pick up. If the container is not picked up within seven days, a demurrage charge will be applied each day until service is scheduled. Please make sure drop off area is clear and accessible. The full per pull charge will be issued if box is unable to be delivered due to issues at the drop off site. *

I acknowledge the above statement (please check box to continue).

Click here Rates for Service .
Click here for Billing and Service Guidelines.

I have read the list and will not dispose of any hazardous waste items in any Milpitas Sanitation collection cart or bin. We will not be able to start your service until you acknowledge this notice. *

I acknowledge the above statement (please check box to continue).

Click here for Hazardous Waste Policy Notice.

I have read the liability waiver. We are not able to start your service until you acknowledge the liability waiver. *

I acknowledge the above statement (please check box to continue).

Click here for Liability Waiver.

Liability waiver name: *

First

Last

Liability waiver site address: *

Address Line 1

City

State

Zip Code

Do you have a completed Milpitas Sanitation credit application on file?: *

Yes - acknowledge and submit
No - click link below

If you do not have a Milpitas Sanitation Credit Application on file, please click here fill-out request form and submit.

Upon request, Milpitas Sanitation will provide tonnage reports. *

I acknowledge the above statement (please check box to continue).

Your account will be charged the rate for loose garbage if the landfill determines your C&D load(s) are contaminated. *

I acknowledge the above statement (please check box to continue).

Projects are encouraged to divert at least 50% of C&D materials from the landfill in accordance with the City of Milpitas Green Building Ordinance. A good faith effort toward diversion is required. *

I acknowledge the above statement (please check box to continue).

For more information on the Green Building Ordinance click here.

Signature:

Submission of this form must include a signature.