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Appendix B <br /> Hauler Tonnage Reporting Form <br /> MOUNDS VIEW <br /> Licensed Hauler Report <br /> ',AII weigh tickets must be available upon request. <br /> Business Reporting <br /> Address,,City State Zip <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 /> Plumber of tons of recycling processed from properties with cart service <br /> Number of tons of recycling processed from multi-unit properties(services separate from <br /> residential route collection i. <br /> Include formula if used to determine cart andlor dumpster weight <br /> Residual garbage in the recycling <br /> 'Jewspaper Cardboard N+303a=ices Plastic Glass Aluminum Tin Cans <br /> Cans <br /> Pry;mds <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 educationalfoutreach 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 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 Reporr <br /> Title <br /> _are <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 5cu evarc'Mo nds View,MN 55112'',7t'3)7174000'Fax(783)717-4019 <br /> aww.moundsv w rn.org'email infc!3�+nouncsvewrnn,rn <br /> City Of Mounds View•2 <br /> Solid Waste and Recycling Standards <br /> DOCSOPEN\MU210\313\990920.v7-10/8/25 <br />