2. Trash Missed Curbside*

   1. Yes

   1. No

   Trash with red $3.00 trash stickers
3. Recycle Missed Curbside*

   1. Yes

   1. No

   Recycling in the 96 gal green bin

5. Date of Service
   Date of Service

   Date of Service
   Select the day of service and the time container was placed curbside with red $3.00 trash stickers
6. Date of Service
   Date of Service

   Date of Service
   Select the day of service and the time recycle bin was placed curbside
8. Trash Stickers (red) $3.00
   -- Select One --123

   How many trash stickers were put on each container(s)?
10. First Name
11. Last Name
13. Address*
15. City
17. Phone Number
19. Email Address
21. Complaint*
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23. 1. Receive an email copy of this form.
24. Email address

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25. Submit Submit and Print

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