Modified Recycling Program Form

DEPARTMENT OF SOLID WASTE MANAGEMENT

APPLICATION FOR COMMERCIAL AND MULTI-FAMILY MODIFIED RECYCLING PROGRAM
1. Name of establishment:
2. Authorized Representative and position/title:
3. Area code and telephone number:
Please enter a valid phone number.Format: (000) 000-0000.
4. Type of establishment:
5. Service location address: (address of establishment where waste is generated)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
6. Mailing Address: (If different from service location address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
7. Number of:
9. Type of Modified Program requested. (Check all that apply and enclose the required information):
10. Affirmation and Signature. This is to affirm that the establishment will begin the Modified Recycling Program within 30 days of Miami-Dade County notification of acceptance of the Program. It is our understanding that the Modified Recycling Program may be reviewed by the County semi-annually and the required documentation will be provided by the establishment upon request.
By
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Title
Should be Empty:

DEPARTMENT OF SOLID WASTE MANAGEMENT