Company Name: ____________________________ (2015 Quarters 3 & 4)
2015 Quarters 3 & 4 Backhauled Recyclable Materials Summary Report
PLEASE ONLY INCLUDE MATERIALS COLLECTED AT FORT COLLINS LOCATIONS
Quantity
MATERIAL VOLUMES
Jul
Aug
Sep
Oct
Nov
Dec
Types of Materials
Total Tons*
Corrugated Cardboard
Shrink Wrap & Plastic Bags
Pallets
Other (please write in material)
Other (please write in material)
Other (please write in material)
Other (please write in material)
Other (please write in material)
Other (please write in material)
Organic Materials
Total Tons*
Donated food
Other (please write in material)
Other (please write in material)
 Continue to page 2 of this form 
*If information is only available in a unit other than tons, please label
Please return completed form by February 12, 2016 to Caroline Mitchell:
[email protected] / 970-224-6177 (fax)
City of Fort Collins Environmental Services • P.O. Box 580, Fort Collins, CO 80522-0580
2/24/2016
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Company Name: ____________________________ (2015 Quarters 3 & 4)
ADDITIONAL QUESTIONS
1. Are there any materials your company produces large quantities of for which you are currently seeking recycling
opportunities?
2. Are all of your materials produced in-house, or do you collect materials from residents or other businesses that are
then back-hauled? If so, which materials?
3. If you are currently donating food, where is it being donated to?
4. Any other comments or thoughts you would like to share?
CONTACT INFORMATION
Name & Title:
(please print)
Date:
Email Address: ____________________________________________________________________________
Phone Number: ______________________________________________________________
2/24/2016
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