Edwin M. Lee, Mayor
Barbara A. Garcia, MPA, Director of Health
City and County of San Francisco
DEPARTMENT OF PUBLIC HEALTH
ENVIRONMENTAL HEALTH
Stephanie K.J. Cushinig, MSPH, CHMM, REHS
Director of Environmental Health
REQUEST FOR DEMAND/PAYOFF
Please submit this request by completing the information below. This request is for
refuse (garbage) liens ONLY. An incomplete request will result in the delay of processing
the demand. A company demand form may be used in lieu of this form.
You may complete this pdf form online. Once completed you may either print it out and fax to
415-252-3875, or save the completed form to your computer and email to [email protected]
ALLOW UP TO 10 CALENDAR DAYS TO PROCESS THIS REQUEST. UPDATES ARE 1 - 2 DAYS.
DEMANDS ARE PROCESSED IN THE ORDER THAT THEY ARE RECEIVED.
NO RUSH REQUEST AVAILABLE. NO VERBAL DEMANDS.
FAX REQUEST TO: (415) 252-3875 OR EMAIL TO: [email protected]
PHONE #: (415) 252-3872
Email Address:
Company Name
Address
Today’s Date:
Escrow Officer
Escrow #
Fax #
Phone #
***PROPERTY INFORMATION***
Service Address
Assessor Parcel#
Owner’s Name
CHECK ONE
☐ SALE
☐ REFINANCE
☐ LOAN
☐OTHER
If OTHER, indicate here.
Invoice #
Invoice #
Invoice #
Invoice #
Invoice #
Invoice #
Invoice #
***LIEN INFORMATION***
Recording Date
Recording Date
Recording Date
Recording Date
Recording Date
Recording Date
Recording Date
SOLID WASTE PROGRAM
1390 Market Street, Suite 210, San Francisco, CA 94102
Phone 415-252-3872 | Fax 415-252-3875