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Form Section 1
Residential Garbage/Recycle Issue Notification
Customer Name
*
First Name
*
Last Name
*
Service Address
*
Email
*
Phone Number
*
City of Woodland Account Number
Issue
*
Choose One
Residential 60 gal Garbage Missed
Residential 60 gal Garbage - Damaged
Residential 60 gal Recycle Missed
Residential 60 gal Garbage - Damaged
Residential 90 gal Garbage Missed
Residential 90 gal Garbage - Damaged
Residential 90 gal Recycle Missed
Residential 90 gal Recycle Damaged
Both Containers Missed (60 gal)
Both Containers Missed (90 gal)
Type of Damage to Container (ex: wheel broken, missing lid, etc.) if applicable
Regular Pick-Up Day
*
Choose One
Monday
Tuesday
Wednesday
Thursday
Friday
disregard this