Please Complete One Response Form For Each Material Fields marked in red are required. This material is: AvailableWanted 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: BulkDrumsPalletsBalesOther Current Amount Units: PoundsTonsGallonsOther Frequency: DailyWeeklyMonthlyQuarterlyYearlyOther Special services/ requirements/descriptions: List Facility Address: YesNo 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. 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.