Form CalRecycle915 "Application for Curbside Registration" - California

What Is Form CalRecycle915?

This is a legal form that was released by the California Department of Resources Recycling and Recovery - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on February 1, 2018;
  • The latest edition provided by the California Department of Resources Recycling and Recovery;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form CalRecycle915 by clicking the link below or browse more documents and templates provided by the California Department of Resources Recycling and Recovery.

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Download Form CalRecycle915 "Application for Curbside Registration" - California

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Application for Curbside Registration
State of California
Department of Resource Recycling & Recovery
CalRecycle 915 (Rev. 2/18)
Mail to: CalRecycle • Division of Recycling • Curbside Section
801 K Street • MS 15-59 • Sacramento, CA 95814-3533
Questions? Call: (916) 323-3008
Instructions
Office Use Only
• Print in Ink or Type.
App. #
New
• Submit a Separate Form for Each Curbside
Curbside ID#
Renewal
Program for Different Agencies
• Indicate N/A for items not Applicable.
Expiration
OPERATOR INFORMATION
1)
Contact Person
First
Middle
Last
Title
1
Organiza
tion Name
Parent Company, If applicable
Fictitious Business Name, If applicable
Business Address
Address
City
County
State
Zip Code
Mailing Address
Address
City
County
State
Zip Code
Telephone Number (
)
(
)
Fax
Type Of Organization
2)
(Check one box)
a.
Individual:
b.
Partnership:
General or
Limited Submit copy of current partnership agreement.
c.
Corporation: Number as filed with Secretary of State
Submit articles of incorporation and list of current corporate officers.
Profit
or
Nonprofit (Select one)
Domestic or
Foreign (Select one)
If foreign, submit copy of certificate from California Secretary of State.
Agent for service of process
d.
Limited Liability Company:
Submit articles of organization, statement of information and operating agreement.
Domestic or
Foreign (Select one)
If foreign, submit copy of certificate from California Secretary of State.
Agent for service of process
e.
Husband and Wife Co-Ownership:
Name of Spouse
f.
Local Government Agency:
City _
___
___
County _
City & County _
Other
___
___
Submit governing board resolution authorizing this application.
g.
Federal Agency:
Military Installation
National Park
Other
Federal Property
Submit governing board resolution authorizing this application.
h.
Joint Power of Authority (JPA)
Submit governing board resolution authorizing this application.
i.
Other: Specify
3)
Submit a copy of the fictitious business name statement, if applicable
4)
Federal ID # (Employer ID#)
Corporations, partnerships and other organizations with paid employees must provide a Federal ID#.
Printed on recycled paper
Print
Clear
Application for Curbside Registration
State of California
Department of Resource Recycling & Recovery
CalRecycle 915 (Rev. 2/18)
Mail to: CalRecycle • Division of Recycling • Curbside Section
801 K Street • MS 15-59 • Sacramento, CA 95814-3533
Questions? Call: (916) 323-3008
Instructions
Office Use Only
• Print in Ink or Type.
App. #
New
• Submit a Separate Form for Each Curbside
Curbside ID#
Renewal
Program for Different Agencies
• Indicate N/A for items not Applicable.
Expiration
OPERATOR INFORMATION
1)
Contact Person
First
Middle
Last
Title
1
Organiza
tion Name
Parent Company, If applicable
Fictitious Business Name, If applicable
Business Address
Address
City
County
State
Zip Code
Mailing Address
Address
City
County
State
Zip Code
Telephone Number (
)
(
)
Fax
Type Of Organization
2)
(Check one box)
a.
Individual:
b.
Partnership:
General or
Limited Submit copy of current partnership agreement.
c.
Corporation: Number as filed with Secretary of State
Submit articles of incorporation and list of current corporate officers.
Profit
or
Nonprofit (Select one)
Domestic or
Foreign (Select one)
If foreign, submit copy of certificate from California Secretary of State.
Agent for service of process
d.
Limited Liability Company:
Submit articles of organization, statement of information and operating agreement.
Domestic or
Foreign (Select one)
If foreign, submit copy of certificate from California Secretary of State.
Agent for service of process
e.
Husband and Wife Co-Ownership:
Name of Spouse
f.
Local Government Agency:
City _
___
___
County _
City & County _
Other
___
___
Submit governing board resolution authorizing this application.
g.
Federal Agency:
Military Installation
National Park
Other
Federal Property
Submit governing board resolution authorizing this application.
h.
Joint Power of Authority (JPA)
Submit governing board resolution authorizing this application.
i.
Other: Specify
3)
Submit a copy of the fictitious business name statement, if applicable
4)
Federal ID # (Employer ID#)
Corporations, partnerships and other organizations with paid employees must provide a Federal ID#.
Printed on recycled paper
AGENCY INFORMATION
5)
Name of Responsible Public Agency (City/County/District)
What Community/Communities Served by this Program
Contact Person
First
Middle
Last
Title
County
Public Agency Department
Business Address
Address
City
County
State
Zip Code
Mailing Address
Address
City
County
State
Zip Code
(
)
Telephone Number (
)
Fax
6)
Initial Program Start Date
7)
Is the operator of the curbside program currently certified by CalRecycle, Division of Recycling, in any category? .............................................
Yes ....
No
If YES, list all valid Certification Number(s)
8)
Provide a dated and signed copy of the current contract, franchise agreement or letter from the responsible public agency, administrative
officer or designee.
9)
Expiration Date of current Acknowledgment or Agreement
10) Provide a current map showing boundaries of the curbside program.
PROGRAM INFORMATION
11) Number of Households Served
Single family residences
Multi-family (2-4 units) residences
Apartment (units) residences
12) Do you also collect empty beverage containers directly from (Check all that apply)
Office buildings
Industrial buildings
Hotels, motels, bars, or restaurants
Other businesses
13) Frequency of Collection (Check all that apply)
Single Family
Weekly
Every 2 weeks
Twice Monthly
Monthly
Weekly
Every 2 weeks
Twice Monthly
Monthly
Multi-Family
Apartments
Weekly
Every 2 weeks
Twice Monthly
Monthly
Other (describe)
14) Method of Collection (Check all that apply)
Single Family
At Curb Manual
At Curb Semi-Automated
At Curb Automated
Backyard
Multi-Family
At Curb Manual
At Curb Semi-Automated
At Curb Automated
Backyard
At Curb Manual
At Curb Semi-Automated
At Curb Automated
Backyard
Apartments
Other (describe)
PROGRAM INFORMATION
(Continued)
15) What recyclable material(s) do you collect or accept?
Aluminum
Glass
Plastic
Bi-metal
Newsprint
White Paper
Computer Paper
Paper Mixed
Magazines
Phone books
Cardboard
Tin
Steel
Other Aluminum
Other Metal
Glass-Mixed
Glass-sorted
Plastic-PETE
Plastic-HDPE
Plastic-Other
Green Waste
Wood
Used Oil
Oil filters
Others:
16) Type of separation at point of collection
Mixed
Sorted
17) Type of containers used at point of collection
None
Bins
Automated Container
Bag
Other (describe):
SORTER INFORMATION
18) Sorter Information #1
Contact Person
First
Middle
Last
Title
Organization Name
__
Fictitious Business Name, If Applicable
Business Address
___
__
___
___
Address
City
County
State
Zip Code
Mailing Address
___
___________________________
_
__
Address
City
County
State
Zip Code
(
)
(
)
__
Telephone Number
Fax
All Location(s)
Where sorting takes place
___
______________________
Address
City
County
State
Zip Code
_______________________
____
_____________________________ ________ _
Address
City
County
State
Zip Code
Sorter Information #2
Contact Person
First
Middle
Last
Title
Organization Name
Fictitious Business Name, If Applicable
Business Address
___
___
_
_______________
Address
City
County
State
Zip Code
Mailing Address
___
__
_
_____________
Address
City
County
State
Zip Code
(
)
Telephone Number (
)
Fax
All Location(s)
Where sorting takes place
_
Address
City
County
State
Zip Code
____
__
_______________________
Address
City
County
State
Zip Code
(Attach additional sheets for sorters as necessary)
19) Provide the name and certification number of the recycling centers and/or processors where the materials are most often sold.
Name
Certification Number
Material Type
Aluminum
Glass
Plastic
Bi-metal
Name
Certification Number
Material Type
Aluminum
Glass
Plastic
Bi-metal
DECLARATION AND SIGNATURES
20) a. I agree to operate the facility in compliance with the California Beverage Container Recycling and Litter Reduction Act, including all relevant regulations contained
in Chapter 5 of Division 2 of Title 14 of the California Code of Regulations.
b. I declare under penalty of perjury under the laws of the State of California that all information on this application and supporting documents is true and
correct and that I am authorized to sign this application.
Note: Please refer to note below (*) for information on who is eligible and required to sign this form.
Executed at
on
City
County
State
(Month/ Day/Year)
Signature
Title
Residence Phone (
)
Printed Name
Residence Address
Address
City
State
Zip Code
Social Security # **
California Driver License #
Executed at
on
City
County
State
(Month/ Day/Year)
Signature
Title
Residence Phone (
)
Printed Name
Residence Address
Address
City
State
Zip Code
Social Security # **
California Driver License #
Executed at
on
City
County
State
(Month/ Day/Year)
Signature
Title
Residence Phone (
)
Printed Name
Residence Address
Address
City
State
Zip Code
Social Security # **
California Driver License #
Executed at
on
City
County
State
(Month/ Day/Year)
Signature
Title
Residence Phone (
)
Printed Name
Residence Address
Address
City
State
Zip Code
Social Security # **
California Driver License #
Attach Additional Sheet if Necessary.
* Who must sign affidavit: For Individuals-the applicant; Partnerships-each partner; Husband & Wife Co-ownerships-both husband & wife; Corporations, Limited Liability
Companies, Government or Public Agencies-persons with authority to legally bind said entity to a contract (e.g., Executive Officer, Managing Member).
** Providing the Social Security Number is voluntary in accordance with the Privacy Act of 1974 (PL 93-579). This information is used for applicant identification
purposes. Authority: California Beverage Container Recycling and Litter Reduction Act (Public Resources Code Section 14500 et seq.).
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