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Appendix B <br />Hauler Tonnage Reporting Form <br />Licensed Hauler Report <br />*All weigh tickets must be available upon request. <br />Business Reporting <br />Addresv'CityStatefZip <br />Emaiq- <br />Phone <br />Reporting Period (Monthi'Year) <br />Number of Residential Properties (Cart Services Only) at which recycling service was pros,iided <br />Number of mobile home carts at which recycling service was pravided <br />Number of tons of recycling processed from properties with cart service <br />Number of tons of reevelinq processed from, mufti -unit PrGpertie-s fservi ces separate from <br />residential route collection). <br />Includeformula it used to determine cart andordumpsterweight <br />Residual garbage in the recycli N <br />Newspaper <br />Cardboard <br />Magazzines <br />PItlStir <br />Glass. <br />A um nuns <br />Cars <br />Tin Cars <br />Pounds, <br />• Fnicky9f, a list of multi -unit property addresses serviced. <br />• Filslis of residential property iddresses not recycling on a regular basis (less than once <br />in two months)., <br />• Enclose any educationaUoutreach materials that hivebeen distributed tocustoniers. <br />Remit report to: Cit� of Mounds View, 2401 Mounds View Boulevard, Mounds View, MN 55112, <br />Attn: Recycling Coordinator <br />I certit, 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 my knowledge.. <br />X Signature <br />Person Completing Report <br />Title <br />Date <br />Failure to remit monthly reports may result in suspension or revocation of your City of Mounds'-,Iiew <br />Hauler License. <br />2401 Mounds View Boulevard' Mounds Vier, <br />MIN 55112 ' e,7d3) 717 -4Z00 ' Fax jd3) 717-4019 <br />www.n--Dundsvie,wrn. n.cou . email: infb4ftmoundsvievmn Drg <br />City Of Mounds View e 2 <br />Solid Waste and Recycling Standards <br />DOCSOPEN\MU210\313\990920.v7-10/8/25 <br />