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• 10/7/15 <br />AGREEMENT <br />® NON-HAZARDOUSTEMPORARY SERVICE <br />' 2498290 <br />4GALLIEGOS PO BOX 1986 FORT COLLINS, CO 80522 <br />-S#rAr#0N Phone: 970-464-5556 Fax: 970-484-0662 <br />INCORPORATED WWW.GALLEGOSSANITATION.COM <br />CUSTOMER•• <br />• <br />Rate <br />"Your Refuse Service Specialistsm. <br />Service Details <br />1.00 <br />Billing Details <br />$100.00 <br />Namel <br />LOVELAND READY MIX <br />Namel <br />LOVELAND READY MIX <br />Name2 <br />1.00 <br />Name2 <br />$150.00 <br />Addressl <br />644 N COUNTY RD 19E <br />Addressl <br />P O BOX 299 <br />Address2 <br />Address2 <br />City <br />LOVELAND <br />City <br />LOVELAND <br />State/Zip <br />CO 80537 <br />State/Zip <br />CO 80539 <br />Phone <br />970-663-9162 <br />Phone <br />970-663-9162 <br />Fax <br />Fax <br />Contact <br />STEPHANIE <br />Contact <br />STEPHANIE <br />Email <br />STEPHANIEH@LRMCONCRETE.COM <br />Email <br />STEPHANIEH@LRMCONCRETE.COM <br />Description <br />Q�t r <br />Rate <br />Amount <br />DELIVERY - LARGE CONTAINER <br />1.00 <br />$100.00 <br />$100.00 <br />30Y ROLLOFF <br />1.00 <br />$375.00 <br />$375.00 <br />R/O MIN SERVICE FEE <br />1.00 <br />$150.00 <br />$150.00 <br />REFUSE -LOOSE <br />1.00 <br />$35.00 <br />$35.00 <br />SPECIAL TERMS <br />By signing this document below, you agree to be bound by the terms/conditions defined on the reverse side of this Service Agreement for Non -Hazardous Waste Disposal. Any <br />modifications to those terms are to be documented in the Special Terms section above. Only then will the changes override the related terms on the back of this document. <br />Customer/Agent Name - Printed <br />Customer/Agent Name - Signature <br />Date of Signature <br />GALLEGOS SANITATION <br />Date <br />