Business Recycling Self Certification Form

Any organization that chooses to self-certify must do so on an annual basis. All self-certifications are also subject to independent verification by the Kern County Public Works Department as required by AB 341 and AB 1826.
A. Business Information
You must complete all questions marked *
Business Name*
Business Owner/ Authorized Designee's Name*
Email*
Street Address (No PO Boxes)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Mailing Address (if different)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone
Fax
B. Solid Waste Estimate
Solid waste generation is the total of all trash, recycling, and greenwaste your organization generates.
Trash Collection Service*
- Yes
- No
Container Size (check all that apply):
- 1 cubic yard
- 2 cubic yards
- 3 cubic yards
- 4 cubic yards
Weekly Pick-up Frequency:
- 1(x)
- 2(x)
- 3(x)
- 4(x)
Recyclable Materials (Blue Cart) Collection Service*
- Yes
- No
Container Size (check all that apply):
- 1 cubic yard
- 2 cubic yards
- 3 cubic yards
- 4 cubic yards
Weekly Pick-up Frequency:
- 1(x)
- 2(x)
- 3(x)
- 4(x)
Organic Materials (Green Cart and Food Waste) Collection Service*
- Yes
- No
Container Size (check all that apply):
- 1 cubic yard
- 2 cubic yards
- 3 cubic yards
- 4 cubic yards
Weekly Pick-up Frequency:
- 1(x)
- 2(x)
- 3(x)
- 4(x)
Solid Waste Self-Hauled:*
- Yes
- No
Amount Disposed:
- Less than one Pick-Up Truck/Trailer Load (6’x5’x2’) per week.
- More than one Pick-Up Truck/Trailer Load (6’x5’x2’)per week.
Based on the above Solid Waste Estimate, check one of the following:*
(Subject to independent verification)
- Business generates less than 4 cubic yards of solid waste per week. Go to Section D-1
- Business generates more than 4 cubic yards of solid per week but NO Recyclable Materials are generated. Go to Section D-2
- Business generates more than 4 cubic yards of solid waste per week. Continue with Sections C & D-3
- Business generates more than 4 cubic yards of organic waste per week. Continue with Sections C & D-3
C. Recycling Information
Materials Recycled (check all that apply):
- Aluminum Containers
- Paper (magazines, newspaper, junk mail, etc.)
- Cardboard
- Metal/Tin/Steel Containers
- Glass Bottles/Jars
- Plastics #1 - #7
- Greenwaste (grass/branches)
- Food Waste
- Other
Other
Facilities or third parties used for recycling, including any gardening services used to comply with AB 1826.
Name of Facility/Third Party Address/Location Materials Recycled
D. Certification
Check One*
- 1. I certify that the foregoing statements are true and complete. I further certify that my business generates less than 4 cubic yards of Solid waste per week therefore, I am exempt from the Recycling requirements of the Kern County Commercial Recycling Ordinance.
- 2. I certify that the foregoing statements are true and complete. I further certify that my business generates more than 4 cubic yards of Solid waste per week but NO Recyclable Materials are generated therefore, I am exempt from the Recycling requirements of the Kern County Commercial Recycling Ordinance.
- 3. I certify that the foregoing statements are true and complete and that I comply with ALL Recycling requirements of the Kern County Commercial Recycling Ordinance.
Electronic Signature*
- By checking here, you hereby affix your legally binding electronic signature to this Online Certification Form.
Signature
Title
Date
MM slash DD slash YYYY
You must complete all questions marked *

A Copy of this form will be e-mailed to you upon submission.
Name
This field is for validation purposes and should be left unchanged.

Business Recycling Self Certification Form

Any organization that chooses to self-certify must do so on an annual basis. All self-certifications are also subject to independent verification by the Kern County Public Works Department as required by AB 341 and AB 1826.

A. Business Information

B. Solid Waste Estimate

C. Recycling Information

D. Certification

A Copy of this form will be e-mailed to you upon submission.

Resources for Commercial Recycling

State & Local Laws/Ordinances:

Outreach Materials:

Links:

Kern County Public Works Department

Quick Links

Name of Facility/Third Party	Address/Location	Materials Recycled