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2. Business Name, DBA*
3. Business Address*
4. City, State*
   -- Select One --Citrus Heights, CA
5. Zip Code*
   -- Select One --9561095621
7. Corp Name, if applicable
8. Corp Address
9. City, State
10. Zip Code
12. How Many Carts are Provided*
13. Cart Photo*

    Upload a photo of each type of cart provided (including toddler cart) for identification purposes. 

16. Cart Size*

    Ex. small, standard, oversize

17. Cart Color(s)*

    List all colors if store has more than one color cart

18. Does the cart have a store logo?*

    1. Yes
    2. No
20. Public Notice & Cart Identification

    Every business providing shopping carts shall have a sign permanently affixed to each cart that includes all of the following information:

    • A valid address, store identity number, telephone number, or some other form of markings that clearly identifies the cart owner
    • Notice to the public that the unauthorized removal of the shopping cart from the premises of the business establishment, or the unauthorized possession of the shopping cart, is a violation of State laws and violation of City ordinance.
22. Loss Prevention Measures*

    Please identify all measures used at this location to aid in the prevention of carts being removed from the premises.  

    Check all that apply:

    1. Carts have wheel locks or other disabling device (preferred)
    2. Carts are not allowed outside the building
    3. Security personnel is used to monitor parking lot
    4. Employees assist customers to vehicle and return cart to store
    5. Other, please describe below
24. Details of Other Loss Prevention Methods
26. Employee Training*

    Please provide the methods used to train employees on measures used to aid in retaining carts on-premise.  

    Check all that apply:

    1. Discussed at regular staff meetings
    2. Discussed at employee orientation
    3. Information included in employee handbook
    4. Other, please describe below
28. Details of Other Employee Training Methods
30. Mandatory Retrieval

    Carts found off-premise may be impounded by the City.  The owner of a properly identified cart will be notified of how to reclaim the cart.  A storage fee will be collected for each cart not picked-up within 3 days following notification.  Carts not retrieved within 10 days will be destroyed.

32. Retrieval Services*

    Does the business use a cart retrieval service?

    1. Yes
    2. No
33. If yes, please provide name of service provider
35. Retrieval Services

    NOTE:  IT IS THE STORE'S RESPONSIBILITY TO UPDATE THIS PLAN IF RETRIEVAL SERVICE PROVIDER CHANGES

39. Contact Information

    Please provide the contact information for the person responsible for implementing this plan

41. Contact Name*
42. Contact Phone*
43. Contact E-mail
45. Acknowledgement*

    I acknowledge the following:

    1. To the best of my knowledge, the above information is true and accurate
    2. This plan shall be implemented within 30 days following approval and will remain in effect until modified.
    3. I certify that all carts provided are properly marked and identified as required
    4. The City has the authority to impound carts and destroy carts in accordance with Article VII, Section 50 of the CHMC
    5. The City has the authority to require the plan be revised due to repeat impoundments
    6. Businesses with excessive impoundments can be required to install wheel locking devices
    7. I understand it is the store's responsibility to notify the City of any changes to the cart retrieval methods, including notification of a change in cart retrieval company.
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47. 1. Receive an email copy of this form.
48. Email address

    This field is not part of the form submission.

49. Submit

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