Waste Exchange Response Form

Please Complete One Response Form For Each Material

Fields marked in red are required.

This material is:
Name of Company or Agency:
Department/Division:
Contact Name:
Date:
Phone:
Fax:
Email:
Web site:
Mailing Address
City
State: Zip:
Type of facility:
Facility Address
City
State: Zip:
Material to be listed:
Packaging:
Current Amount
Units:
Frequency:
Special services/
requirements/descriptions:
List Facility Address:
If no what is to be
listed instead:

By submitting this form, you accept full responsibility for the accuracy of the information given and agree to provide additional documentation if required by Los Angeles County Sanitation Districts (LACSD). New or modified listings will be posted within in two working days. If you agree click Submit Form when you've finished.

Please enter the word above in the text box below.

Contact Mark Giljum at 562-908-4288, extension 2456 or at mgiljum@lacsd.org for any questions about this form or the Districts' Recycling and Waste Exchange Program.