Great American Cleanup

2. Neighborhood Association
4. Contact Name
5. Email Address
7. Address
8. Phone Number
12. Type of Dumpster*
    -- Select One --trashlandscape

    You will receive a confirmation email from City staff when your dumpster has been confirmed. Twenty (20) dumpsters are reserved for the Great American Cleanup. 

14. 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.

15. Upload a Map (OPTIONAL)

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

17. Is the Dumpster on Private Property?*
    -- Select One --yesno
19. 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). 

    
    

20. Owner's Phone Number
24. Number of Flyers

    Limit of 100 copies

25. Number of Plastic Gloves (Non-Latex)

    Limit of 75 pairs

27. Number of Plastic Trash Bags (TRASH DUMPSTERS ONLY)

    Limit of 75 bags

28. Number of Yard Waste Bags (LANDSCAPE DUMPSTERS ONLY)

    Limit of 75 bags

30. Volunteers
    -- Select One --yesno

    You can request volunteers to help with your community cleanup. 

Leave This Blank:


32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit

* indicates a required field