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You are not guaranteed a date; this form is based on a first-come, first-served basis; we will contact you with an available date if one comes available for your Zone date.
Name
Address for container *
Telephone
Alt Phone

ALL CONTAINERS CAN ONLY BE DROPPED OFF IN THE DRIVEWAY; PLEASE GIVE DETAILED INSTRUCTIONS OF WHERE ON THE DRIVEWAY. Example: Driveway far north/Driveway second one on the east. If there are no instructions, put Driveway.
I am the homeowner of the property identified on this form, and that I have authority to allow WFWRD staff to place a SCRP container on my property. *

I agree to not place or allow to be placed any unauthorized items in or around the container. These items include the following: hazardous waste including asbestos, solvents, paints, hydrocarbons, oil products, pesticides, herbicides, propane, gasoline, freon, batteries, engines or transmissions, fuel/oil tanks of any kind, or barrels, or ammunition of any kind.

I am responsible for any damages and or theft of the container while on my property. o This includes damage above and beyond normal wear and tear, paint or chemicals spilled damage, fire damage, or other damages. WARNING: Skid steers, track hoes and back hoes can cause damage to the container when loading

 The container must be placed entirely on my property and cannot impede or obstruct sidewalks or roadways. If these requirements cannot be met, due to space and/or obstructions, I understand that the container will not be delivered

The container will be used only for residential waste, and not for commercial/contractor or industrial disposal.

Not to fill the container above the top. I agree not to load the container more than 24 inches of concrete, gravel, rock, sod or dirt. If the container is overloaded, I agree to unload the container to the acceptable load limit. Driver’s discretion will determine the excess amount to be removed. o WFWRD employees will not collect any waste placed outside of the container or on the curbside

I release and will hold harmless WFWRD and its employees from any and all liability, damage, or injury resulting to persons or property during the placement, stay or removal of the container on my property, whether or not I am present when the container is delivered or collected.