Moloka'i 'Opala Collection Appointment Request Form

Moloka'i

'Opala Collection

Appointment Request Form

MAUNALOA RESIDENTS ARE INVITED TO DROP OFF MATERIALS TO THE MMN COLLECTION SITE ON FRIDAY, JUNE 2

TO REQUEST A PICK UP PLEASE CHECK THE BOX BELOW

Pick Up Request

Check this box to request a pick up.

Pick up approval & schedule will be provided via phone and/or email

Pick ups are scheduled Wednesday May 31 or Thursday June 1

Select your preferred pick up date here:

Address

Please enter your full address and any access stipulations or helpful instructions.

First Name*

Last Name*

Select or enter value

Freon appliances

Refrigerators, Freezers, Air Conditioners & Water Coolers

***(all accepted materials must be void of ANY food or fluid prior to pick up or drop off)***

nonFreon appliances

Dishwashers, Stoves, Water Heaters, Washers & Dryers

***(all accepted materials must be void of ANY food or fluid prior to pick up or drop off)***

Scrap Metal

Example: Metal pieces and parts, sheet metal, tire rims, lawn mowers & weed eaters

***(all accepted materials must be void of ANY food or fluid prior to pick up or drop off)***

Estimate total # of pounds

Scrap Metal Item Description

Please provide a descrition of the scrap metal materials

Electronics

Enter total quantity

Landfill Waste

Estimate total # of pounds

Tires

Enter total quantity

Lead Acid Battery

Enter total quantity

Phone*

Comments

For items not included in the categories above please list them here; MMN staff will contact you to accept or deny any additional materials.

RSVP for Thursday Luncheon

Enter the total number joining MMN staff & volunteers for a post event luncheon

Send me a copy of my responses