Fillable Application For Project Roll-Off Account

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Application For Project Roll-Off Account

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U.S.A. forms for City of Helena

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CITY OF HELENA PROJECT ROLL-OFF ACCOUNT
Phone: 406-447-8082 Fax: 406 447-8083
Email: Solidwaste@helenamt.gov
DATE ROLL-OFF ACCOUNT APPLICATION *
START DATE: ____________________________________
BUSINESS NAME: __________________________________ ACCOUNT #: __________________
CONTACT NAME: ___________________________________ RAMSPR #: ____________________
CONTACT #: __________________________ ___________ USER #: _______________________
BILLING CONTACT INFORMATION: SERVICE LOCATION:
NAME: _____________________________ ____________________________________
ADDRESS: _____________________________ ____________________________________
_____________________________
IF BILLING ADDRESS IS P.O. BOX – A PHYSICAL ADDRESS IS REQUIRED: ___________________________
___________________________
TELEPHONE: _____________________________ EMAIL: ___________________________
CONTAINER SIZE: 10 YD 20 YD 30 YD 40 YD
PLACEMENT INSTRUCTIONS: _____________________________________________________________
_______________________________________________________________________________________
_____________________________________________________________________________________
________________________________________ ___________________________
BILLING CONTACT SIGNATURE DATE
Tonnage allowed in Container is based on the size of Roll-off rented.
Additional weight in container billed at current Commercial Rates
Container contents cannot exceed 20000 Pounds
***
DO NOT OVERFILL CONTAINER
***
Debris and trash must not extend above the sides of the container
Overfilled containers will not be serviced until material is removed
*Upon completion, fax (406-447-8083) email (solidwaste@helenamt.gov),
or return form to Transfer Station Scalehouse
CITY OF HELENA TRANSFER STATION
PRE-ACCEPTANCE AGREEMENT
The City of Helena Solid Waste Division reserves the right to inspect any load or portion of a load arriving at our
facility. We will reject all prohibited wastes and any unacceptable waste as determined by our management. The
following materials
will not be accepted
in Roll-off containers at the City of Helena Transfer Station:
HA
ZARDOUS WASTE
PCB WASTE
LIQUIDS
MEDICAL WASTES
ASBESTOS
BULK OR LOOSE VERMICULITE
BULK OR LOOSE INSULATION
LARGE CONCRETE
EXPLOSIVE TANKS (i.e. propane tanks, gas, waste oil, etc.)
All w
aste in container is subject to current Transfer Station rates.
Per Item Fees on:
TIRES
FREON UNITS
MATTRESSES
If you rent a Roll-off container and are discovered to be disposing of prohibited materials, your actions will be
reported to the regulatory agency of the State of Montana Solid Waste Program. In addition, you will be required to
pay for all costs associated with the clean-up, transport and disposal of prohibited wastes at both the City of Helena
Transfer Station and the Lewis & Clark County Landfill to a facility of our choice. You may also lose future Transfer
Station disposal privileges.
DO NOT OVERFILL CONTAINER
Container contents cannot exceed 20000 Pounds
Debris and trash must not extend above the sides of the container
Overfilled containers will not be serviced until material is removed
BILLING CYCLE STARTS OVER EACH TIME CONTAINER IS DUMPED AND RETURNED
Waste Generator/Customer agrees and warrants that he/she is disposing only non-regulated solid waste in the City
of Helena Roll-off Containers and does hereby indemnify the facility/operator for damages caused by delivery of any
hazardous, toxic or otherwise unacceptable material.
NOTICE
•
Any damage to container while in customer’s possession shall be the responsibility of the customer.
•
Any damage to tarp due to overloading of the container shall be the responsibility of the customer.
Customer will be responsible for repair costs and materials to Container or Tarp if damaged. In the event the
container is damaged beyond repair customer will cover cost of container replacement to include freight charges.
By signing below – you agree to the above terms & conditions.
Waste Generator/Customer Signature Date
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Application For Project Roll-Off Account

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Completed 12 July 2020

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