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Appendix B <br /> Hauler Tonnage Reporting Form <br /> 1IIDS VIEW <br /> Licensed Harder Report <br /> -M weigh tickets must be available upon request. <br /> Business Reporting <br /> Add ressfC ity+Sta te!Zip <br /> Eniaii Phone <br /> Reporting Period {MonthlYear} <br /> Number of Resi:ential Properties(Cart Services Only)atwhieh recycling service was provided <br /> Plumber of mobile home carte at which recycling service was provided <br /> Plumber of tons of recycling processed from properties with cart service <br /> Number of tons of recvrainq processed from muki-unit Properties(ser%ices separate from <br /> residential'route collection)_ <br /> Irtcliudeformulaif used todeterminecartandlordumpsterwe.i ht <br /> Respdual garbage in the recy Ring <br /> Newspaper Cardboard Magazines Plastic Class AYumirtum Tin Cars <br /> Carts <br /> Pounds <br /> ■ Enclose a Iist of multi-unit property addresses serviced, <br /> ■ Enclose a list of residential property addresses not recycling on a regular basis (less than once <br /> in two months), <br /> ■ Enclose any ed Pic ationalloutreach materials that have been distributed to customers, <br /> Remit report to: City of Mounds View, 2401 Mounds View Boulevard, Mounds View- MN 55112. <br /> Atcn: Recycling Coordinator <br /> I certify, as an authorized representative of the above- canted 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 subm ted is true,accurate. and complete to the hest of my knowledge- <br /> Sign@ tLre <br /> Person Compfemg Report <br /> Title <br /> Dare <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 BGmewarc'Mounds View.UN 55112'703)717-40'70'Fax(M)717-40113 <br /> wwwr.nwundsuiewmFn.om'email:inioK52nounasv.ewrnn.oM <br /> City Of Mounds View■3 <br /> Solid Waste and Recycling Standards <br /> DOCSOPEN\MU210\313\990920.v5-11/21/24 <br />