Type Full Name :
Sign With Hand
Property Address
Date Set
{[CITY]}, {[STATE]} {[ZIP]}
Geographic Location
Dumpster Location
Secondary Dumpster Location Description
Applicant Signature
Primary Dumpster Location Description
Amount Due
Phone #
Applicant Information
By signing this waiver, you are releasing the Borough of Blakely from any damage that might incur while placing or removing the dumpster from your property. In addition, you are acknowledging that none of the following items will be placed into the dumpster:

ELECTRONICS                             ROOF                        SHINGLES                            DIRT                        STONE

MULCH                                    CONCRETE               CINDER BLOCKS                   BRICKS

APPLIANCES                           BATTERIES                       TIRES

Failure to comply with these requirements will result in additional fees to correct any infractions. Minimum dumpster fee is $200 per dump and there is a one-week time limit unless authorized by borough management. Your dumpster will be delivered within 7 days of your order. Requests sooner than 7 days in advance will be carried out to the best of the borough’s ability.
Container Type
Date of Pickup
# of Dumps