Dumpster Program

2. Neighborhood Association
4. Contact Name
5. Email Address
7. Address
8. Phone Number
12. Date
    Date

    Date

    Dumpsters are available Saturdays from 8 AM - Noon between April and November. 

    You will receive a confirmation email from city staff when your dumpster is confirmed. Choosing a date does not guarantee availability of a dumpster.

13. Type of Dumpster*
    -- Select One --trashlandscape
15. Exact Location of Dumpster

    Let us know where you want us to put the dumpster. Feel free to attach a map if you need to provide extra details.

16. Upload a Map (OPTIONAL)

    This step is only necessary if the location does not have a street address.

18. Is the Dumpster on Private Property?*
    -- Select One --yesno
20. Name of Property Owner

    The owner and applicant, in consideration of the promise of the city of Peoria to provide a dumpster (or a garbage truck) at the above listed location for use during an organized neighborhood cleanup, hereby waives any claim for damages or injuries caused by the city of Peoria or the business providing the dumpster (or truck), its agents, officers, or employees, arising from the placement of said dumpster (or truck). 

    
    

21. Owner's Phone Number
23. Number of Flyers

    Limit of 100 copies

Leave This Blank:


25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

* indicates a required field