prefix *

 Mr.   Mrs.   Miss

First and last name *

Telephone number *

Example: 08xxxxxxxxx

Address of the informant (if any)

Location/point where residual garbage was found *

Types of residual waste *

-- Select --General garbagerecycled wasteOrganic waste/food scrapsLarge pieces of garbage (furniture/mattresses)Branches/garden scrapsOther

Estimated quantity *

-- Select --Little (1-2 bags)Medium (3-5 bags)A lot (more than 5 bags/pile)1-2 large pieces of garbageMany large pieces of garbage

The date the garbage was found *

urgency *

-- Select --Very urgent (smelly/obstructive/risk of disease)Urgent (should be stored quickly)Mediumgeneral

Landmarks/Nearby Places

Convenient time to contact

-- Select --08:30-12:0013:00-16:30Contact us at any time.