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2. Requesting City of Granbury Employee Name*
3. Requesting City of Granbury Department*
4. Date of Submission*
   Date of Submission
6. Request Type *

   1. Purge
   2. Special Event
7. Will location #1 need barricaded off the day prior for drop off?*

   1. Yes
   2. No
8. Requesting City Employee After Hours Contact Number*
10. ADDRESS of Location #1*
11. Alternative Location #1 Name*
12. Location #1 Delivery or Purge Request Date*
    Location #1 Delivery or Purge Request Date
14. If you are requesting an alternative container type for location #1, rather then a roll off please indicate below.
15. Location #1; Pick Up Date*
    Location #1; Pick Up Date
17. Additional Roll Off Locaiton*

    1. Yes
    2. No
18. Request Type*

    1. Purge
    2. Special Event
19. Will location #2 need barricaded off the day prior for drop off?*

    1. Yes
    2. No
21. ADDRESS of Location #2*
22. Alternative Location #2 Name*
23. Location #2 Delivery or Purge Request Date*
    Location #2 Delivery or Purge Request Date
25. If you are requesting an alternative container type for location #2, rather then a roll off please indicate below.
26. Location #2 Pick Up Date*
    Location #2 Pick Up Date
28. Additional Notes:
Leave This Blank:


30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit

* indicates a required field