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2. Name of Business*
4. Mailing Address*
6. Name of Requester*
7. Phone # of Requester*
9. Email Address of Requester*
11. Reason for temporary exemption:*

    1. Need additional time to draw down supply of single-use plastic bags, non-recyclable paper bags, or expanded polystyrene food service products.
    2. Retail establishment has unique circumstances and there are no reasonable alternatives to single-use plastic bags, non-recyclable paper bags, or expanded polystyrene food service products.
    3. Other (please explain)
13. Explanation
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15. 1. Receive an email copy of this form.
16. Email address

    This field is not part of the form submission.

17. Submit

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