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.......... <br />X: X. <br />Contact Person —Email Address <br />Emergency Contact Infonnation <br />If completed license should be mailed somewhere other than the business address, please attach separate sheet. <br />Recvclina services will be provided to (check all that apply): <br />Residential Commercial Multifamily Industrial <br />Number of vehicles the applicant proposes to use in the collection of recyclables <br />Name and address of companies or materials recovery facility where recyclable s will be delivered: <br />07=70M <br />'W17% <br />IfficepaperlBoxboard* Corrugated Cardboardt' <br />*Required 'Items for residential and multifamily haulers <br />CanslPlasfic* <br />Y <br />I have been provided with a copy of the City of Roseville Curbside Recycling Ordinance and understand that violation of any of the <br />provisions included in the ordinance may result in suspension or rcvocation of the license. <br />i X1 <br />I have attached a certificate of liability ins 1 1 <br />,a ertiApate indicating Worker Compensation coverage, and the fee of $125.00. <br />Date H pf! <br />., tWature Title <br />