Refuse Special Haul Request Form

Refuse Special Haul Request

Before a special haul request can be conducted, you will need to fill out this form so a refuse staff member can contact you. There is a minimum charge of $25.00 for any request. If your special haul is for more than that, then you will be billed for the cost for the haul.

Refuse Special Haul set rates:

Add specifics here for known charges:

Today's Date:(Required)

Date Special Haul is Requested for (if not today's date)

Please note we do not do pickups on weekends or major holidays.

Applicant Name:(Required)

First Last

Person who is on site to rent hydrant.

Applicant Organization/Company Name (if applicable)

Business Name

Name of business, if applicable and if it’s different than the customer name.

Applicant Phone Number:(Required)

Customer Drivers' License Number or tax ID number (Required)(Required)

Enter your tax ID number, UBI number, or government issued ID number such as a driver’s license.

Email Address:

Entering your email will send you a copy of this form and your bill once your account is billed.

Mailing Address:(Required)

Street Address Address Line 2 City State ZIP Code

Street Address:

Street Address Address Line 2 City State ZIP Code

If different from mailing address.

Special Haul Location:(Required)

List location/s the request is for. Can include cross streets, property details, etc..

Special Haul Items(Required)

Air Conditioner

Junk Pile

Mattress

Refrigerator/Freezer

Other

Comments:

Signature(Required)

FOR OFFICIAL CITY OF YAKIMA USE ONLY

All fields below are for City Of Yakima staff use only.

Driver: ______________________________

SPECIAL HAUL PICKUP DATE: ______________________________

SPECIAL HAUL TOTAL AMOUNT: ______________________________

ADDITIONAL CHARGES OR NOTES:

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