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Appendix B <br />Hauler Tonnage Reporting Form <br />AM <br />Movrms ViEw <br />Licensed Hauler Report <br />*All weigh tickets must be available upon request. <br />Business Reporting <br />Add ressf C ity.'StatefZip <br />Email <br />Phone <br />Reporting Period (Month±Year) <br />Number of Residential Properties (Cart Services Only) at which recycling service was provided <br />Number of mobile home carts at which recycling service was provided <br />Number of tans of recycling processed from properties with cart service <br />Number of tons of recyclinq processed from multi -unit properties (services separate from <br />residential route ccWlection)_ <br />I nclude formula if used to determine cart and+or dumpster weight <br />Residual garbage in the recycling <br />Newspaper Cardboard Magazines Plastic Glass. Aluminum Tin Cans <br />Cans <br />Pounds <br />■ Enclose a list of multi -unit property addresses serviced, <br />■ Enclose a list of residential property addresses not recycling on a regular basis (Jess than once <br />in two months), <br />■ Enclose any educationalrautreach materials that have been distri buted to customers. <br />Remit report to; City of Mounds View, 2401 Mounds Vieux Boulevard, Mounds View, MINI 55112, <br />Attn: Recycling Coordinator <br />I certify, as an authorized representative of the above-named company, that I have personally <br />examined and am familiar with the information submitted in response to the questions contained in <br />this report, and all information submitted is true, accurate, and complete to the best -of myknowledge_ <br />X Sigma tare <br />Person Corrrplefirrg Report <br />Trtfe <br />Date <br />Failure to remit monthly reports may result in suspension or revocation of your City of Mounds View <br />Hauler License_ <br />2401 Mounds'View Baukvarc ' Mw nds View, MN 55112 ' {793) 717-4000 ' Fax (793) 717AO 10 <br />www.rnoundsuiew nn.mg' email: inftK'6 rMcundsvi2wmn_orp <br />City of Mounds View * 18 <br />Solid Waste and Recycling Standards <br />