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Appendix B <br /> Hauler Tonnage Reporting Form <br /> MOUNDS VIEW <br /> Licensed Hauler Report <br /> 'All weigh tickets must be available upon request. <br /> Business Reporting <br /> Address/City/StatelZip <br /> Email 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 tons of recycling processed from properties with cart service <br /> Number of tons of recycling processed from mutti-unit properties(senices separate from <br /> residential route collection)- <br /> Include formula if used to determine cart and/or dumpster weight <br /> Residual garbage in the recycling <br /> 'Jewspaper Cardboard Magazines Plastic Glass Aluminum Tin Caps <br /> Cans <br /> Prxmds <br /> • Enclose a list 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 educationattoutreach materials that have been distributed to customers. <br /> Remit report to: City of Mounds View, 2401 Mounds View Boulevard, Mounds View, MN 55112, <br /> Attn: Recycling Coordinator <br /> I certify, as an authorized representative of the above-named company, that I have personalty <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 View <br /> Hauler License. <br /> 2401 Mounds View 6cu evarc'Mounds View,AN 55112'(703)7174000'Fax(783)717-4019 <br /> www.rnoundsviewmn.oro'email_info(t4 nounosvewmn om <br /> City Of Mounds View•2 <br /> Solid Waste and Recycling Standards <br /> ,,/?,Q-4DOCSOPEN\MU210\313\990920.v7-10/8/25 <br />