Waste Concierge Program - Submit Materials

Section 1: Contact Information

Your Name

First NameLast Name

Your Title

Company Name

Email Address

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Extension

If applicable

Mailing Address

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Section 2: Material Information

What Item/Material are you Submitting?

What material/item are you looking to divert?

Description of Item/Material

Please include: 1. Whether it is new or used? 2. If used, what condition is it in? 3. What the item/material was used for? 4. Can shipping/delivery be provided within Greater Victoria, or is pick-up required? 5. How is the material packaged? 6. How long can the material be stored?

Frequency Generated

E.g., one time, weekly, bi-weekly, monthly, etc.

Upload Photo(s) of the Item/Material

Accepted file types: jpg, jpeg, png, gif, heic

Total Weight of Item/Material (kg)

Your best estimate

Total Value of Item/Material if Purchased New ($)

Your best estimate

How would you dispose of the item/material if not diverting through this program?

Please indicate how you would dispose of this item if you were not participating in this program.

My Item/Material Contains the Following:

What type of WOOD does this material/item contain? (Check all that apply):

Rows	My item material contains:
Plywood
Treated/painted wood
MDF/particleboard
Mixed wood/unsure
Clean solid wood (hard/soft)
Other (please specify)

What type of METAL does this material/item contain? (Check all that apply):

Rows	My item material contains:
Aluminum
Copper
Steel (carbon)
Steel (stainless)
Copper/brass
Mixed metals/unsure
Other (please specify)

What type of PLASTIC does this material/item contain? (Check all that apply):

Rows	My item material contains:
PET (#1 - bottles, containers)
HDPE (#2 - jugs, cleaning bottles)
PP (#5 - food containers, bins)
PS rigid (hard plastics)
Mixed rigid plastics
Plastic film / wrap
Shrink wrap
Mixed plastics/unsure
Other (please specify)

What type of GLASS does this material/item contain? (Check all that apply):

Rows	My item material contains:
Clear glass
Coloured glass
Tempered glass
Mixed glass/unsure
Other (please specify)

What type of PAPER/CARDBOARD does this material/item contain? (Check all that apply):

Rows	My item material contains:
Corrugated cardboard
Boxboard (cereal box-type packaging)
Office paper
Newspaper
Laminated paper
Mixed paper/unsure
Other (please specify)

What type of TEXTILES does this material/item contain? (Check all that apply):

Rows	My item material contains:
Cotton (e.g., towels, sheets)
Polyester
Wool
Mixed textiles/unsure
Other (please specify)

What type of FOAM does this material/item contain? (Check all that apply):

Rows	My item material contains:
Polyurethane foam
Styrofoam / EPS
Mixed foam/unsure
Other (please specify)

What type of ORGANICS does this material/item contain? (Check all that apply):

Rows	My item material contains:
Food waste
Cooking oil
Garden waste
Mixed organics/unsure
Other (please specify)

What OTHER materials does this material/item contain?:

Rows	Material type:
Material 1 (please specify)
Material 2 (please specify)
Material 3 (please specify)
Material 4 (please specify)
Material 5 (please specify)

Additional Information

Please provide any additional details that may help identify an organization interested in accepting the material.

Section 3: Confirmation

I agree to the Terms and Conditions of the Circular Catalyst program, and I understand that if a community non-profit organization or recycler within the Circular Catalyst Program network can accept this material, an introduction will be facilitated using the information provided in this form.