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B A I: E R S F I E L D
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NEW/END COMMERCIAL REFUSE SERVICE ~~
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AUTHORIZE THE CITY OF BAKERSFIELD T0: (Please indicate request below)
_ BEGIN NEW SERVICE (Reminder: Automated carts are only serviced once per week.)
OF BIN(S) or CART(S): SIZE: BIN(S) SIZE: CART(S) PICK-UP FREQUENCY:
1.5 CY 2 CY 3 CY SMALL LARGE 1 2 3 4 5 6
ADD LOCKING SERVICE (COMBINATION: )
END OF SERVICE
REASON: CLOSING /RELOCATING /OTHER
(Please indicate forwarding or new location address under Billing Information; Section C)
EFFECTIVE DATE: I/~l/t^ l 07
Section B -Service Location Information fPlease print or type
BUSINESS NAME: ~iN/d-~C~' ~q~cCJl~,v;.~
LOCAL BUSINESS TEL ~: ~vTo J ' ~3~3 r- s~ ~a
SERVICE ADDRESS: ~ 1 f `7 ~ ~~"FLt~ ~ ~
ACCOUNT NUMBER: _~~ ~ f`- % -• l C- ~ =~
NAME: LS,r,~ ~ H'i"'~D
ADDRESS: ~b ( Sl~9~~{ v~- /~U''~ ~
CITY, STATE, ZIP: A~!~<(t.G~~ ~ ~Z~3i 3
TELEPHONE x: ~ (o ~ ` 1~0 ' cam; 7 ? S
FAX €:
CONTACTPERSON:
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CITY SOLID WASTE DIVISION
4101 TRUXTUN AVE, BLDG. A
BAKERSFJELD, CA 93309
FAX: (661)852-2121
PHONE: (661) 326-3114
Ut~~er Informabon tYlease pnni or
NAME:
ADDRESS:
CITY, STATE, ZIP: -
TELEPHONE Y:
FAX =`:
CONTACT PERSON:
****NOTE****; COMMERCIAL REFUSE CUSTOMERS WILL BE REQUIRED TO PAY A DEPOSIT EQUIVALENT TO THE
MONTHLY SERVICE LEVEL THEY ARE REQUESTJNG. WHEN THE ACCOUNT IS TERMINATEDICLOSED
THE DEPOSIT WILL BE REFUNDED LESS ANY OUTSTANDIIJG BALANCES IF APPLICABLE.
ACCOUNTS 60 DAYS DELINQUENT WILL BE STOPPED UNTIL ACCOUNT IS BROUGHT CUP,RENT.
AUTHGRIZED SIGNATURE:
TITLE: OC,W (/i `~ DATE:
(mice use only)
Deposit Payment Method: Cash: Check: Credit Cerd: Amoun?: S
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