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WASTE HAULER FORM
WASTE HAULER FORM
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Printable Version
Waste Hauler Form
ALL INFORMATION IS TO BE COMPLEETED IN FULL BY SEPTAGE HAULER MIXING OF LOAD IS PROHIBITED
WASTE HAULER INFORMATION
All Waste Haulers must fill out information sheet COMPLETELY. It must be signed by the owner of the residence or business.
City will only accept waste that is hauled within a 10-mile radius of Monticello City Limits with the Eastland area being an exception.
FEES: $30.00/1000 Gallons within city limits
FEES: $60.00/1000 Gallons within a 5-mile radius of city limits
FEES: $70.00/1000 Gallons 5-10 miles and Eastland area
NO WASTE ACCEPTED OUTISDE THE 10-MILE RADIUS EXCEPT EASTLAND
*
Name
*
Address
*
Telephone Number
*
Truck Make and Model
*
Truck Capacity
*
Truck License Number
SOURCE OF WASTE
*
Name of Residence or Business
*
Name of Owner
*
Address
*
Telephone Number
*
Location
Please Choose One
City
5 Mile Radius
Outside 5-10 Mile Radius and Eastland area
*
Type of Waste
Please Choose One
Residence
Business
Grey Water
*
Time waste was pumped and date
*
Time arrived at plant and date
*
Quantity Hauled
*
Waste Sampled
Please Choose One
Yes
No
Have additives been mixed with waste??
Please Choose One
Yes
No
If YES, please explain
I HEARBY CERTIFY THAT THE ABOVE INFORMATION IS TRUE AND AGREE THAT FALSEFICATION OR FAILURE TO COMPLY WITH THE TERMS OF CITY'S WASTE HAULER AGREEMENT WILL RESULT IN REFUSAL OF DISCHARE INTO CITY'S WASTEWATER SYSTEM AND LEGAL ACTION
*
Owner Signature and Date
*
Waste Hauler Signature and Date
Submit
Submit Bid
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