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Name and address of each trazisfer station, dispasal faci�ity and composting facility used for each of the following; <br />(attach additional pages if needed) <br />Garbage <br />� <br />Yard WasteBrush <br />� .�'_ .�..,• <br />1 <br />� <br />Cop�struction/Demolition Debris <br />Organics <br />�p�oO�N (. <br />Include a copy of th� disclosure form used to infarm customers of the disposal facilities used by the applicant. <br />Residential Customer Rates <br />Please include a!! relevant ta�css and fees including surcharges, <br />These will i�e published and otl�erwise made available to residents. <br />Sarvi ce <br />32 Gallon Service* <br />64 Gallan Service* <br />96 Gallon Servica* <br />Walk-up Service* <br />Additional Garbage� <br />Yarcf Waste* <br />*These services are required to be offered in Roseville. <br />Cost. <br />17. 7S (per month} <br />_��r _� , {per month) <br />•%� (pet' month) <br />C�� (per month) <br />�� <br />� <br />I have been provided with a copy of the City of Roseville Solid Waste Collection Ordinance and tmderstand that violation <br />ofthe provisions included in the ordinance may result in suspension or revocation ofthe license. <br />I have atCached a certificate of lzability insurance, a certificata indicating Worker Compensation coverage, the fee of <br />$125.00, and a copy of th s al facility disclosure form, <br />A s gnature <br />_ �t?a1ti1 Q, <br />Title ` <br />z � �3 <br />Date <br />