Debris Box Service Request

To request Debris Box Service please complete all the required information below and submit.

PO#:

Customer name: *

First

Last

Email *

Company / Owner Name:

Site address *

Address Line 1

City

State

Zip Code

Site phone number: *

Site email *

Billing address: *

Address Line 1

City

State

Zip Code

Billing phone number: *

Billing email: *

Type of customer: *

Residential
Commercial

Note: E-waste, mattresses, and appliances are prohibited. If these items are found in our boxes or bins, you will be charged an extra fee. We no longer provide bins for stable waste. All debris box customers will be required to pay a pre-payment per box per pull. The pre-payment is $500.00, $1,000.00, $1,500.00, or $2000.00 per box per pull. *

I acknowledge the above statement (please check box to continue)

Requested delivery date: *

Debris box size: *

Debris box material (choose all that apply): *

If recyclables single - stream selected please list type:

Debris box location: *

Street
Driveway
Other

Please list address / placement / other details here:

There is a debris box placement fee of $69.97. I have read the rate sheet / misc. rate sheet and acknowledge the rate for this service. I understand that service cannot begin without acknowledgement of the applicable service rate. *

I acknowledge the above statement (please check box to continue)

CLICK HERE for RATE FOR SERVICE.

Unincorporated county commercial rate based on distance from office, please contact LSI for appropriate rate. *

I acknowledge the above statement (please check box to continue)

I have read the billing and service guidelines. We will not be able to start your service until you acknowledge these guidelines. Billing includes: A placement fee, per pull charge and tonnage charge for each pick up or attempt to pick up. If the container is not picked up within seven days, a demurrage charge will be applied each day unit service is scheduled. *

I acknowledge the above statement (please check box to continue)

Click here for Debris Box Billing and Service Guidelines.

I have read the list and will not dispose of any hazardous waste items in any Livermore Sanitation collection cart or bin. We will not be able to start your service until you acknowledge this notice. *

I acknowledge the above statement (please check box to continue)

Click here for Hazardous Waste Policy Notice .

I have read the liability waiver. We will not be able to start your service until you acknowledge the liability waiver. *

I acknowledge the above statement (please check box to continue)

Click here for Liability Waiver .

Liability waiver name: *

Liability waiver site address: *

Address Line 1

City

State

Zip Code

Do you have a completed LSI credit application on file?: *

Yes - acknowledge and submit
No - click link below

If you do not have a LSI Credit Application on file, please fill-out request form and submit. Click here to submit LSI Credit Application.

Debris box material construction and demolition?:

Yes (continue to following)
No (form can be submitted at the bottom of the page

I have read the construction and demolition survey notes. We will not be able to start your service until you acknowledge the construction and demolition survey notes.

I acknowledge the above statement (please check box to continue)

Click here for the Construction and Demolition Survey .

Does your project fit the municipal code's definition? (City of Livermore municipal code chapter 15.28 listed above):

Yes
No

Do you have a permit with the city of Livermore?:

Yes (list permit number below)
No

Permit number:

Describe your project:

By having services and/or an account with LSI, you agree to our General Information, Terms and Conditions. *

I acknowledge the above statement (please check box to continue)

Click here for our General Information, Terms and Conditions.

Please type your name as your signature: *

By submitting this form I acknowledge I have read all required guidelines and the liability waiver. *

I acknowledge the above statement (please check box to continue)

Debris Box Service Request

*Required