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4. Today's Date*
   Today's Date
5. Which Cart is Broken?*
   -- Select One --Grey Trash CartBlue Recycle CartBoth Trash and Recycle Carts
6. Your Trash/Recycle Pickup Day*
   -- Select One --MondayTuesdayWednesdayThursday
8. Did the Driver Tag Your Cart as "Broken"?
   -- Select One --YesNo
9. *City of Port Hueneme does not replace dirty/smelly carts free of charge. Please soak dirty/smelly carts with hot water mixed with Simple Green, vinegar or household dish detergent, and rinse the cart out in an area the mixture can be safely absorbed (such as a dirt or lawn area). Please do not allow mixture to run into a stormdrain.
11. First Name*
12. Last Name*
14. Residence Address (where broken cart is located)*
16. Account Address (if different from above)
18. *Please put broken cart out on your next regular pickup day, and once it is empty, the driver will come back and replace it later that same day. (If we are notified before 2:00 on your pickup day, we should be able to replace the cart the same day, as long as it is still empty)*
20. Phone Number (if you would like confirmation by phone)
22. E-Mail Address (if you would like confirmation by e-mail)
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24. 1. Receive an email copy of this form.
25. Email address

    This field is not part of the form submission.

26. Submit

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