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PRIVATE STORMWATER VACTOR WASTE DISPOSAL TRACKING FORM Maintenance Contractor-Please Remember To: 1. Complete one of these forms for each facility/site being maintained in Redmond. 2. Include a copy of your original disposal /dump receipt with this form. 3. Please sign this form in the area provided below. 4. After completing steps 1-3, mail, fax, or e-mail to the City at the address/number listed below. Maintenance Contractor Company Name: Property Management Company or Property Owner: Address where work was performed: Date work was completed: Disposal date: Approximate sediment tons removed from above site: Disposal Facility Used: By signing below, I hereby state that the above information is true and correct. Signature, Maintenance Contractor Representative Date Mail, Fax, or E-mail information to: Redmond Public Works, MS-2NPW C/O Scott McQuary P.O. Box 97010 Redmond, WA. 98073-9710 Phone: (425) 556-2826 Fax: (425) 556-2820 E-mail: [EMAIL REDACTED] Updated 2/11/21