Amador Chipping Program

CONTACT INFORMATION

First Name *

Last Name *

Email *

Phone * i.e. xxx-xxx-xxxx

Address Number *

Street Name *

City *

ZIP Code *

Assessors Parcel Number * numeric only, no dashes

Nearest Cross Street

Are you the owner of the land? *

Yes

CHIPPER INFORMATION

Number of Piles *numeric only

Total size of piles, in Feet, combined *numeric only

Width:

(X)Length:

(X)Height:

Approximately how many acres of property did you clear? *numeric only

Where is the material? *

Driveway

Shoulder of Road

Other (Explain)

What would you do with this material if this program were not available? *

If you would take it to a landfill or disposal facility, how many miles(round trip) is that? *

Is this application part of a planned Community Chipping Day ?

Yes

Who prepared the pile? *

I cut and stacked the material myself

I hired someone to cut and stack the material

How many hours did it take you?

If you hired someone, how much did it cost?

By providing my electronic signature below I acknowledge and certify the following:

I have completed the requirements on the Chipper Program Page and agree to allow the Amador Resource Conservation District (ARCD) staff and private contractor admittance onto my property in order to access the pile for chipping. I understand that the material will be chipped back onto my property. I understand that the ARCD provides this service through contracts with private chipping companies. The contractor has final authority to determine if a pile is suitable for chipping. I understand that if the pile is not prepared per the checklist, it will not be chipped. ARCD provides the contractors with a preferred weekly schedule, but final decisions for scheduling of chipping are made by the contractor. In addition, I will comply with the chipping crews' decisions as to where chipped material is deposited because safety is their foremost concern. I will not make any attempt to load brush into the chipping machine. I understand that all work will be halted if this attempt is made. I understand that ARCD is not obligated to perform this service and that ARCD is not liable for its failure to perform this service or for the negligent performance of this service. The applicant agrees to hold harmless, indemnify, and to defend the ARCD and its employees from and against any and all claims for injury or damage arising from or connected with the work associated with this request, except for any such claim arising solely out of negligent acts or omissions attributable to the ARCD and its employees. It is understood that the duty to indemnify and hold harmless includes the duty to defend as set forth in Section 2778 of the California Civil Code.

Your Signature:

* (adding your name to this box is your authorized digital signature)

I have read, and agree to the above statement and submit my digital signature of approval. *

REQUEST FOR CHIPPING