{"id":6335,"date":"2026-06-09T14:38:49","date_gmt":"2026-06-09T21:38:49","guid":{"rendered":"https:\/\/www.yakimawa.gov\/services\/utility-services\/?page_id=6335"},"modified":"2026-06-09T14:38:49","modified_gmt":"2026-06-09T21:38:49","slug":"refuse-special-haul-request-form","status":"publish","type":"page","link":"https:\/\/www.yakimawa.gov\/services\/utility-services\/refuse-special-haul-request-form\/","title":{"rendered":"Refuse Special Haul Request Form"},"content":{"rendered":"<script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_13' >\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">Customer Refuse Special Haul Request<\/h2>\n                            <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_13'  action='\/services\/utility-services\/wp-json\/wp\/v2\/pages\/6335' data-formid='13' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_13' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_13_1\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Customer Refuse Special Haul Request<\/h3><div class='gsection_description' id='gfield_description_13_1'>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 without the minimum $25.00 charge. For more info, visit: https:\/\/www.yakimawa.gov\/services\/refuse\/ or call 509-575-6005.<\/div><\/div><div id=\"field_13_75\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">HAZARDOUS MATERIALS ARE NOT ALLOWED<\/h3><div class='gsection_description' id='gfield_description_13_75'>HAZARDOUS MATERIALS NOT ALLOWED: Batteries of any kind, Propane tanks, Oxygen tanks, Paint cans, or Liquids that can easily catch fire or emit flammable vapors (gasoline, diesel fuel, ethanol). Please contact Terrace Heights Landfill at 509-574-2450 for questions about that. \n<\/div><\/div><div id=\"field_13_59\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Refuse Special Haul set rates:<\/h3><div class='gsection_description' id='gfield_description_13_59'>Add specifics here for known charges: <\/div><\/div><div id=\"field_13_9\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_13_9'>Today&#039;s Date:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_9' id='input_13_9' type='text' value='' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_13_9_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_13_9_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_13_9' class='gform_hidden' value='https:\/\/www.yakimawa.gov\/services\/utility-services\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_13_66\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_13_66'>Date Special Haul is Requested for (if not today&#039;s date)<\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_66' id='input_13_66' type='text' value='' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_13_66_date_format gfield_description_13_66\" aria-invalid=\"false\" \/>\n                            <span id='input_13_66_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_13_66' class='gform_hidden' value='https:\/\/www.yakimawa.gov\/services\/utility-services\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><div class='gfield_description' id='gfield_description_13_66'>Please note we do not do pickups on weekends or major holidays. <\/div><\/div><fieldset id=\"field_13_3\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-seven-twelfths gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Applicant Name:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_13_3'>\n                            \n                            <span id='input_13_3_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_3.3' id='input_13_3_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_13_3_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_13_3_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_3.6' id='input_13_3_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_13_3_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><div class='gfield_description' id='gfield_description_13_3'>Person who is on site to rent hydrant.<\/div><\/fieldset><fieldset id=\"field_13_5\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-seven-twelfths field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Applicant Organization\/Company Name (if applicable)<\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name no_last_name no_suffix gf_name_has_1 ginput_container_name gform-grid-row' id='input_13_5'>\n                            \n                            <span id='input_13_5_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_5.3' id='input_13_5_3' value=''   aria-required='false'     \/>\n                                                    <label for='input_13_5_3' class='gform-field-label gform-field-label--type-sub '>Business Name<\/label>\n                                                <\/span>\n                            \n                            \n                            \n                        <\/div><div class='gfield_description' id='gfield_description_13_5'>Name of business, if applicable and if it&#8217;s different than the customer name.<\/div><\/fieldset><div id=\"field_13_16\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-five-twelfths gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_13_16'>Applicant Phone Number:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_16' id='input_13_16' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_13_65\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-five-twelfths gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_13_65'>Customer Drivers&#039; License Number or tax ID number (Required)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_65' id='input_13_65' type='text' value='' class='large'  aria-describedby=\"gfield_description_13_65\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_13_65'>Enter your tax ID number, UBI number, or government issued ID number such as a driver&#8217;s license. <\/div><\/div><div data-fieldId=\"65\" class=\"spacer gfield\" style=\"grid-column: span 7;\" data-groupId=\"a5c27418\"><\/div><div id=\"field_13_25\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-five-twelfths field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_13_25'>Email Address:<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_25' id='input_13_25' type='email' value='' class='medium'     aria-invalid=\"false\" aria-describedby=\"gfield_description_13_25\" \/>\n                        <\/div><div class='gfield_description' id='gfield_description_13_25'>Entering your email will send you a copy of this form and your bill once your account is billed.<\/div><\/div><div data-fieldId=\"25\" class=\"spacer gfield\" style=\"grid-column: span 7;\" data-groupId=\"04ccaaef\"><\/div><fieldset id=\"field_13_7\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-five-twelfths gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Mailing Address:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_13_7' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_13_7_1_container' >\n                                        <input type='text' name='input_7.1' id='input_13_7_1' value=''    aria-required='true'    \/>\n                                        <label for='input_13_7_1' id='input_13_7_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_13_7_2_container' >\n                                        <input type='text' name='input_7.2' id='input_13_7_2' value=''     aria-required='false'   \/>\n                                        <label for='input_13_7_2' id='input_13_7_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_13_7_3_container' >\n                                    <input type='text' name='input_7.3' id='input_13_7_3' value=''    aria-required='true'    \/>\n                                    <label for='input_13_7_3' id='input_13_7_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_13_7_4_container' >\n                                        <select name='input_7.4' id='input_13_7_4'     aria-required='true'    ><option value='' selected='selected'><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                        <label for='input_13_7_4' id='input_13_7_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_13_7_5_container' >\n                                    <input type='text' name='input_7.5' id='input_13_7_5' value=''    aria-required='true'    \/>\n                                    <label for='input_13_7_5' id='input_13_7_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_7.6' id='input_13_7_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div data-fieldId=\"7\" class=\"spacer gfield\" style=\"grid-column: span 7;\" data-groupId=\"56cbfe9b\"><\/div><fieldset id=\"field_13_17\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-five-twelfths field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Street Address:<\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_13_17' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_13_17_1_container' >\n                                        <input type='text' name='input_17.1' id='input_13_17_1' value=''    aria-required='false'    \/>\n                                        <label for='input_13_17_1' id='input_13_17_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_13_17_2_container' >\n                                        <input type='text' name='input_17.2' id='input_13_17_2' value=''     aria-required='false'   \/>\n                                        <label for='input_13_17_2' id='input_13_17_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_13_17_3_container' >\n                                    <input type='text' name='input_17.3' id='input_13_17_3' value=''    aria-required='false'    \/>\n                                    <label for='input_13_17_3' id='input_13_17_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_13_17_4_container' >\n                                        <select name='input_17.4' id='input_13_17_4'     aria-required='false'    ><option value='' selected='selected'><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                        <label for='input_13_17_4' id='input_13_17_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_13_17_5_container' >\n                                    <input type='text' name='input_17.5' id='input_13_17_5' value=''    aria-required='false'    \/>\n                                    <label for='input_13_17_5' id='input_13_17_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_17.6' id='input_13_17_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><div class='gfield_description' id='gfield_description_13_17'>If different from mailing address. <\/div><\/fieldset><div data-fieldId=\"17\" class=\"spacer gfield\" style=\"grid-column: span 7;\" data-groupId=\"40a1ad7a\"><\/div><div id=\"field_13_11\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-five-twelfths gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_13_11'>Special Haul Location:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_11' id='input_13_11' type='text' value='' class='large'  aria-describedby=\"gfield_description_13_11\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_13_11'>List the specific location\/s the request is for. This can include cross streets, property details, etc.. Prices may vary based on placement of items. For example, if a you have special haul items located in the alley, backyard, or another area that is not easily accessible by our grapple truck, additional charges which can range from $25 &#8211; $250 will be applied for the removal, depending on the amount of items you have.<\/div><\/div><div data-fieldId=\"11\" class=\"spacer gfield\" style=\"grid-column: span 7;\" data-groupId=\"be5553fd\"><\/div><fieldset id=\"field_13_69\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-five-twelfths gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Special Haul Items<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_13_69'><div class='gchoice gchoice_13_69_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.1' type='checkbox'  value='Air Conditioner (portable) - $38.00'  id='choice_13_69_1'   aria-describedby=\"gfield_description_13_69\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_1' id='label_13_69_1' class='gform-field-label gform-field-label--type-inline'>Air Conditioner (portable) &#8211; $38.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.2' type='checkbox'  value='Accent Chair - $10.00'  id='choice_13_69_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_2' id='label_13_69_2' class='gform-field-label gform-field-label--type-inline'>Accent Chair &#8211; $10.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.3' type='checkbox'  value='BBQ (no tank) - $15.00'  id='choice_13_69_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_3' id='label_13_69_3' class='gform-field-label gform-field-label--type-inline'>BBQ (no tank) &#8211; $15.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.4' type='checkbox'  value='Bicycle - $10.00'  id='choice_13_69_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_4' id='label_13_69_4' class='gform-field-label gform-field-label--type-inline'>Bicycle &#8211; $10.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.5' type='checkbox'  value='Book Shelf - $10.00'  id='choice_13_69_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_5' id='label_13_69_5' class='gform-field-label gform-field-label--type-inline'>Book Shelf &#8211; $10.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.6' type='checkbox'  value='Car Tire with rim - $5.00'  id='choice_13_69_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_6' id='label_13_69_6' class='gform-field-label gform-field-label--type-inline'>Car Tire with rim &#8211; $5.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.7' type='checkbox'  value='Car Tire without rim - $4.00'  id='choice_13_69_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_7' id='label_13_69_7' class='gform-field-label gform-field-label--type-inline'>Car Tire without rim &#8211; $4.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.8' type='checkbox'  value='Couch - $20.00'  id='choice_13_69_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_8' id='label_13_69_8' class='gform-field-label gform-field-label--type-inline'>Couch &#8211; $20.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.9' type='checkbox'  value='Dining Chair - $5.00'  id='choice_13_69_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_9' id='label_13_69_9' class='gform-field-label gform-field-label--type-inline'>Dining Chair &#8211; $5.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.11' type='checkbox'  value='Dishwasher - $15.00'  id='choice_13_69_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_11' id='label_13_69_11' class='gform-field-label gform-field-label--type-inline'>Dishwasher &#8211; $15.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.12' type='checkbox'  value='Dresser - $10.00'  id='choice_13_69_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_12' id='label_13_69_12' class='gform-field-label gform-field-label--type-inline'>Dresser &#8211; $10.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.13' type='checkbox'  value='File Cabinet - $10.00'  id='choice_13_69_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_13' id='label_13_69_13' class='gform-field-label gform-field-label--type-inline'>File Cabinet &#8211; $10.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.14' type='checkbox'  value='Freezer (residential) - $38.00'  id='choice_13_69_14'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_14' id='label_13_69_14' class='gform-field-label gform-field-label--type-inline'>Freezer (residential) &#8211; $38.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_15'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.15' type='checkbox'  value='Hide-a-bed - $25.00'  id='choice_13_69_15'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_15' id='label_13_69_15' class='gform-field-label gform-field-label--type-inline'>Hide-a-bed &#8211; $25.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_16'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.16' type='checkbox'  value='Hot Tub Cover - $20.00'  id='choice_13_69_16'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_16' id='label_13_69_16' class='gform-field-label gform-field-label--type-inline'>Hot Tub Cover &#8211; $20.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_17'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.17' type='checkbox'  value='Junk Pile (quote will be provided by refuse dept)'  id='choice_13_69_17'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_17' id='label_13_69_17' class='gform-field-label gform-field-label--type-inline'>Junk Pile (quote will be provided by refuse dept)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_18'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.18' type='checkbox'  value='Lawn Mower (fluids removed) - $25.00'  id='choice_13_69_18'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_18' id='label_13_69_18' class='gform-field-label gform-field-label--type-inline'>Lawn Mower (fluids removed) &#8211; $25.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_19'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.19' type='checkbox'  value='Mattress\/Box Spring - $10.00'  id='choice_13_69_19'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_19' id='label_13_69_19' class='gform-field-label gform-field-label--type-inline'>Mattress\/Box Spring &#8211; $10.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_21'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.21' type='checkbox'  value='Microwave - $5.00'  id='choice_13_69_21'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_21' id='label_13_69_21' class='gform-field-label gform-field-label--type-inline'>Microwave &#8211; $5.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_22'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.22' type='checkbox'  value='Office Chair - $10.00'  id='choice_13_69_22'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_22' id='label_13_69_22' class='gform-field-label gform-field-label--type-inline'>Office Chair &#8211; $10.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_23'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.23' type='checkbox'  value='Pallets (each) - $5.00'  id='choice_13_69_23'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_23' id='label_13_69_23' class='gform-field-label gform-field-label--type-inline'>Pallets (each) &#8211; $5.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_24'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.24' type='checkbox'  value='Play Pen\/Crib - $5.00'  id='choice_13_69_24'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_24' id='label_13_69_24' class='gform-field-label gform-field-label--type-inline'>Play Pen\/Crib &#8211; $5.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_25'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.25' type='checkbox'  value='Recliner (or similar size) - $15.00'  id='choice_13_69_25'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_25' id='label_13_69_25' class='gform-field-label gform-field-label--type-inline'>Recliner (or similar size) &#8211; $15.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_26'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.26' type='checkbox'  value='Refrigerator (residential) - $38.00'  id='choice_13_69_26'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_26' id='label_13_69_26' class='gform-field-label gform-field-label--type-inline'>Refrigerator (residential) &#8211; $38.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_27'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.27' type='checkbox'  value='Sectional (per piece) - $20.00'  id='choice_13_69_27'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_27' id='label_13_69_27' class='gform-field-label gform-field-label--type-inline'>Sectional (per piece) &#8211; $20.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_28'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.28' type='checkbox'  value='Shower Door (set) - $10.00'  id='choice_13_69_28'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_28' id='label_13_69_28' class='gform-field-label gform-field-label--type-inline'>Shower Door (set) &#8211; $10.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_29'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.29' type='checkbox'  value='Stove - $15.00'  id='choice_13_69_29'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_29' id='label_13_69_29' class='gform-field-label gform-field-label--type-inline'>Stove &#8211; $15.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_31'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.31' type='checkbox'  value='Table (under 5ft) - $10.00'  id='choice_13_69_31'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_31' id='label_13_69_31' class='gform-field-label gform-field-label--type-inline'>Table (under 5ft) &#8211; $10.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_32'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.32' type='checkbox'  value='Table (over 5ft) - $15.00'  id='choice_13_69_32'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_32' id='label_13_69_32' class='gform-field-label gform-field-label--type-inline'>Table (over 5ft) &#8211; $15.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_33'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.33' type='checkbox'  value='Toilet - $10.00'  id='choice_13_69_33'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_33' id='label_13_69_33' class='gform-field-label gform-field-label--type-inline'>Toilet &#8211; $10.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_34'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.34' type='checkbox'  value='Truck tire (with rim) - $11.00'  id='choice_13_69_34'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_34' id='label_13_69_34' class='gform-field-label gform-field-label--type-inline'>Truck tire (with rim) &#8211; $11.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_35'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.35' type='checkbox'  value='Truck tire (without rim) - $6.00'  id='choice_13_69_35'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_35' id='label_13_69_35' class='gform-field-label gform-field-label--type-inline'>Truck tire (without rim) &#8211; $6.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_36'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.36' type='checkbox'  value='Vacuum - $5.00'  id='choice_13_69_36'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_36' id='label_13_69_36' class='gform-field-label gform-field-label--type-inline'>Vacuum &#8211; $5.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_37'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.37' type='checkbox'  value='Washer\/Dryer (per piece) - $15.00'  id='choice_13_69_37'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_37' id='label_13_69_37' class='gform-field-label gform-field-label--type-inline'>Washer\/Dryer (per piece) &#8211; $15.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_38'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.38' type='checkbox'  value='Water Heater (drained) - $15.00'  id='choice_13_69_38'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_38' id='label_13_69_38' class='gform-field-label gform-field-label--type-inline'>Water Heater (drained) &#8211; $15.00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_69_39'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.39' type='checkbox'  value='Other (quote will be provided by refuse dept.)'  id='choice_13_69_39'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_69_39' id='label_13_69_39' class='gform-field-label gform-field-label--type-inline'>Other (quote will be provided by refuse dept.)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_13_69'>Select all that apply. HAZARDOUS MATERIALS NOT ALLOWED: Batteries of any kind, Propane tanks, Oxygen tanks, Paint cans, or Liquids that can easily catch fire or emit flammable vapors (gasoline, diesel fuel, ethanol). For more info, visit: https:\/\/www.yakimawa.gov\/services\/refuse\/ or call 509-575-6005.<\/div><\/fieldset><div data-fieldId=\"69\" class=\"spacer gfield\" style=\"grid-column: span 7;\" data-groupId=\"6fe869fd\"><\/div><div id=\"field_13_70\" class=\"gfield gfield--type-post_image gfield--input-type-post_image gfield--width-five-twelfths field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_13_70'>Photo of Item\/s<\/label><div class='ginput_complex ginput_container ginput_container_post_image gform-grid-row'><span class='ginput_full gform-grid-col'><input name='input_70' id='input_13_70' type='file' class='large'   aria-invalid=\"false\" aria-describedby=\"gfield_upload_rules_13_70 gfield_description_13_70\" \/><span id='gfield_upload_rules_13_70' class='gfield_description gform_fileupload_rules'>Accepted file types: jpg, jpeg, png, gif.<\/span><\/span><\/div><div class='gfield_description' id='gfield_description_13_70'>Please upload a photo of the item or items you are requesting a special haul quote for. Please be sure to limit the file size so you can submit the form. <\/div><\/div><div data-fieldId=\"70\" class=\"spacer gfield\" style=\"grid-column: span 7;\" data-groupId=\"7e9a1675\"><\/div><div id=\"field_13_72\" class=\"gfield gfield--type-post_image gfield--input-type-post_image gfield--width-five-twelfths field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_13_72'>Photo of Item\/s<\/label><div class='ginput_complex ginput_container ginput_container_post_image gform-grid-row'><span class='ginput_full gform-grid-col'><input name='input_72' id='input_13_72' type='file' class='large'   aria-invalid=\"false\" aria-describedby=\"gfield_upload_rules_13_72 gfield_description_13_72\" \/><span id='gfield_upload_rules_13_72' class='gfield_description gform_fileupload_rules'>Accepted file types: jpg, jpeg, png, gif.<\/span><\/span><\/div><div class='gfield_description' id='gfield_description_13_72'>Please upload a photo of the item or items you are requesting a special haul quote for. Please be sure to limit the file size so you can submit the form. <\/div><\/div><div data-fieldId=\"72\" class=\"spacer gfield\" style=\"grid-column: span 7;\" data-groupId=\"cb1449aa\"><\/div><div id=\"field_13_71\" class=\"gfield gfield--type-post_image gfield--input-type-post_image gfield--width-five-twelfths field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_13_71'>Photo of Item\/s<\/label><div class='ginput_complex ginput_container ginput_container_post_image gform-grid-row'><span class='ginput_full gform-grid-col'><input name='input_71' id='input_13_71' type='file' class='large'   aria-invalid=\"false\" aria-describedby=\"gfield_upload_rules_13_71 gfield_description_13_71\" \/><span id='gfield_upload_rules_13_71' class='gfield_description gform_fileupload_rules'>Accepted file types: jpg, jpeg, png, gif.<\/span><\/span><\/div><div class='gfield_description' id='gfield_description_13_71'>Please upload a photo of the item or items you are requesting a special haul quote for. Please be sure to limit the file size so you can submit the form. <\/div><\/div><div data-fieldId=\"71\" class=\"spacer gfield\" style=\"grid-column: span 7;\" data-groupId=\"fa567232\"><\/div><div id=\"field_13_68\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_13_68'>Comments:<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_68' id='input_13_68' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_13_20\" class=\"gfield gfield--type-signature gfield--input-type-signature gfield--width-three-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_13_20'>Signature<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><input type='hidden' value='' name='input_20' id='input_13_20_signature_filename'\/><div class='gfield_signature_ui_container gform-theme__no-reset--children' ><div id='input_13_20_Container' class='gfield_signature_container ginput_container' style='height:180px; width:300px; ' ><canvas id='input_13_20' width='300' height='180' style='border-style: Dashed; border-width: 2px; border-color: #DDDDDD; background-color:#FFFFFF; cursor: url(https:\/\/www.yakimawa.gov\/services\/utility-services\/wp-content\/plugins\/gravityformssignature\/assets\/img\/pen.cur), pointer;'><\/canvas><\/div><div id='input_13_20_toolbar' style='margin:5px 0;position:relative;height:20px;width:300px;max-width:100%;'><img id = 'input_13_20_resetbutton' src='data:image\/png;base64,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' style='cursor:pointer;float:right;height:24px;width:24px;border:0px solid transparent' alt='Clear Signature' \/ ><\/div><input type='hidden' id='input_13_20_data' name='input_13_20_data' value=''><\/div><\/div><div id=\"field_13_48\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">FOR OFFICIAL CITY OF YAKIMA USE ONLY<\/h3><div class='gsection_description' id='gfield_description_13_48'>All fields below are for City Of Yakima staff use only. <\/div><\/div><div id=\"field_13_39\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Driver: ______________________________<\/h3><\/div><div id=\"field_13_49\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">SPECIAL HAUL PICKUP DATE: ______________________________<\/h3><\/div><div id=\"field_13_40\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">SPECIAL HAUL TOTAL AMOUNT: ______________________________<\/h3><\/div><div id=\"field_13_47\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">ADDITIONAL CHARGES OR NOTES:<\/h3><div class='gsection_description' id='gfield_description_13_47'>______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________<\/div><\/div><div id=\"field_13_67\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">** If the form doesn&#039;t allow you to submit it due to the file size of the photo\/s, remove the photo\/s and resize before submitting again.**<\/h3><\/div><\/div><\/div>\n        <div class='gform-footer gform_footer top_label'> <input type='submit' id='gform_submit_button_13' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' 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