JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Tier One Commercial Edible Food Generator Survey
The City of Lakewood (City) has identified that your business meets a definition of a Tier One Commercial Edible Food Generator, or may be serviced by one. Beginning January 1, 2022, Tier One Commercial Edible Food Generators must comply with edible food recovery requirements defined in SB 1383. Your response to this survey is critical to the City’s SB 1383 Edible Food Recovery programming and planning efforts.
We appreciate your prompt response in completing the survey.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Tier One Commercial Edible Food Generator Survey
1. Company Name
*
Your answer
2. EDCO Account Number
*
Your answer
3. Lakewood Company Address (i.e. 123 Main St, Lakewood, CA, 90712)
*
Your answer
4. Mailing Street Address (if different from your site address)
Your answer
5. Contact Name (person completing survey)
*
Your answer
6. Contact Email (person completing survey)
*
Your answer
7. Food Donation/Recovery Contact (if different from above)
Your answer
8. Food Donation/Recovery Contact Phone (if different from above)
Your answer
9. Food Donation/Recovery Contact Email (if different from above)
Your answer
10. Tier One Commercial Edible Food Generator Type (check one item below)
*
Supermarket or Grocery Store
Wholesale Food Vendor
Food Distributor
Food Service Provider (either you are the Food Service Provider, or you are a business in Lakewood receiving services from a Food Service Provider)
None. My business does not meet any of the Tier One Commercial Edible Food Generator definitions. (Please explain in question #14)
11. If you answered "None" above, please explain.
Your answer
12. If you selected Food Service Provider in question 10, proceed to question 13. Otherwise, please proceed to question 17.
Your answer
13. Please provide Food Service Provider's company name and corporate address:
Your answer
14. Please provide Company name and address in Lakewood where food services are being provided:
Your answer
15. Please provide best local contact (name, email, phone #), if not already provided
Your answer
16. List the type(s) of food services provided. Examples include a full-service cafeteria, restaurant, deli, cage, pre-packaged market, coffee cart, vending machine, in-house catering for meetings and events, etc.
Your answer
17. Does this establishment donate its excess edible food to a food recovery service or organization? If No, proceed to question 18. If Yes, proceed to question 19.
*
Yes
No
18. If No to question #17 above: what are the barriers or concerns you face in donating? After answering, please proceed to question 24.
Your answer
19. If Yes to question #17 above: What pantry/non-profit partners do you donate to? If multiple, please list them.
Your answer
20. If Yes to question #17 above: Do you have written agreements with the pantry/non-profits you donate to?
Yes
No
Clear selection
21. If Yes to question #17 above: Do you maintain records of the foods donated?
Yes
No
Clear selection
22. If you answered No in question #21: Does the pantry/non-profit maintain records and provide them back to you?
Yes
No
Clear selection
23. Please explain barriers or concerns to donating the maximum amount of edible food possible.
Your answer
24. The City or its authorized contractor will be contacting your business to schedule a site visit. During this visit we will: confirm your company’s eligibility as a Tier 1 Generator; provide additional information on SB 1383 Edible Food Recovery requirements; provide resources to assist your business with compliance; and ask additional questions about your edible food recovery program. What are the best times and days of your week for the City to meet at your establishment?
*
Your answer
Please provide any additional information or comments, if applicable.
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
