* Required Information |
| *Date: |
| *Name of Company or Agency: |
| *Name of Owner or Responsible Person: |
*Phone: Fax:
E-mail: |
| Credit Account No. w/LACSD: |
| or Cash Account No. w/LACSD: |
| *Select the appropriate landfill: |
| Project Area Number(s) from LACSD's Grid Map: (Optional) |
*Project Address:
*City: |
*Total Tonage Requested: *Duration of Project:
*Starting Date: |
Any Comments or Questions?
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| 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). If you agree and when you've finished, click here to |
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| For any questions about this form or the Districts' Landfill Registration Program send an e-mail to swCustService@lacsd.org, or contact Carlotta Contreras at 562-908-4876 if you are a cash account customer, or contact Nancy Hayes at 562-908-4876 if you are a credit account customers. |
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