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CITY OF JEROME OVERNIGHT TRUCK REQUEST Charge: $30.00 Date Needed: / / Delivery Address: Parking Location: Name: Phone Number: The following items are NOT allowed on city trucks when the trucks are left at residences or businesses for trash disposal: Batteries, Appliances, Tires, Wood, and/or Chemicals. I hereby certify that I will NOT load batteries, appliances, tires, wood, and/or chemicals on any city truck. A 24 HOUR NOTICE FOR CANCELLATION OR DATE CHANGE IS REQUIRED. IF 24 HOUR NOTICE IS NOT RECEIVED THE TRUCK WILL BE DELIVERED ON THE REQUESTED DATE Signature Received by Date Received / / D e l i v e r c o m p l e t e d f o r m t o P u b l i c W o r k s D e p a r t m e n t .