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Name and address ot'each transfer station, disposal facility and composting facility used for each of the following: <br />(attach additional pages if needed) <br />Garbage �! Construction/Demolition Debris <br />����� I 1'1�, 1't7a n S-� �-� i ��� ZU �O��l�� �fi .��" �� r� <br />N�� � ����� .i ��.� � w� � l <br />Yard `Vaste/Brush <br />�� C� i�n <br />� r�� l� `�� Ci) YYI ��,� o. i�` <br />Organics <br />Include a copy of the disclosure form used to inform customers of the disposal facilities used by the applicant. <br />Residential Customer Rates <br />Please include all relevant taxes and fees includin� surcharges. <br />These will be published and otherwise made available to residents. <br />Service <br />� �_ <br />J � 3�-Gallon Service* <br />�> -� Gallon Service* <br />� � -�6 Gallon Service* <br />Walk-Lip Service* <br />AdditionaL Garba�e* <br />Yard Waste* <br />Organics <br />*These services are rec�uired to be offered in Roseville. <br />Cost <br />� �� �� (per mouth) <br />� �� � �� (per mouth) <br />� �..�� L� (per mon[h) <br />i <br />�/� � � ��� � (;� (per month) <br />�.�� � ���� <br />�� � <br />�;�11 io( u0 -f� <br />I have been provided with a copy of the Ciry of Roseville Solid Waste Collection Ordinance and understand that violation <br />of the provisions included in the ordin�nce may result in suspension or revocation of the license. <br />I have attached a certificate of Iiability ins�irance, a certificate indicating Worker Compensation coverage, the fee of <br />S 12�.00, ar.d a copy of the disposal faciliry disclosure form. <br />�� <br />�� �L1�,lJi �)��t���2 �1 <br />App(icant's Signature <br />r 1 <br />-f-�� Vl'1! n 1 �-�i'�� t �,�,Q ��.;�i �,r`�i`�LL <br />Title <br />! 1—�1- I � <br />Date <br />