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A Pplicatio <br />'Kecyclina Hauler Licens.,..... <br />C7 W.W 4 <br />Emergency Contact, Information <br />If completed license should be mailed somewhere other than the business address, please attach separate sheet. <br />Rcicycling services will be provided to (check all that apply), <br />Residential lCommercial Multifamily Indlu,strial <br />Number of'vehilcles the applicant. proposes to use in the collection of recyclables <br />Name anid address olf companies or materials recovery facility where recyclables will be delivered: <br />Newspri'nu* Uft Glass * <br />tj IN Canslplaslic * <br />,Of <br />.fice,paperlBoxboliard Corrugated Cardboard'* Other(�Iease spec,-fy) <br />0 14 f iep-lw P-A fe 4 Pe� <br />*Required iterns for residential and multifamily haulers <br />I have been provided with a copy, of the City of Roseville Curbside Reicycling Ordinance and understand that violation of any of the <br />Provisions included, in the ordinance may result in suspension or revocation of the license. <br />I have r 'hed a certific te of jability insuranc-e, z certificate Indicating Worker Compensation coverage, and the fee of Sl 25-00. <br />Date Applicant's Signature Title <br />