HomeMy WebLinkAbout1635 FRAZIER AVE; ; CBR2024-1003; RecyclePART 2 Complete before final inspection, obtain City Approved hauler receipts and return prior to final
building approval.
DEBRIS RECYCLING REPORT (ACTUAL):
SECTION A Acknowledgement
I certify under penalty of perjury under the laws of the State of California that the information provided in and with
this form pertains to construction and demolition debris generated only from the project listed in PART 1, that I have
reviewed the accuracy of the information, and that the information is true and correct to the best of my knowledge
and belief.
Permit No.CpR '2-0"2.4 -1 o 03> Print Name
Address l62?S ~'2-i e..r ~
Use this Final Log below to track loads of materials as they leave the job site.
@@SAVE RECEIPTS@@
Indicate FINAL quantities in tons for each material and save receipts and documents from facilities where material is taken.
Additional Project Log pages are available if necessary. Use City Conversion Table to convert volume to tons.
A B C
Date Material Type Actual Amt Actual Amt Actual Amt Destination Facility
Reused or Recycled Disposed in (Name, Address, Phone)
Salvaged Landfill
Exam12_Je: Palomar Transfer Station, 5960 El
01/01/2020 Concrete (broken) 5 tons Camino Real
-760 603-0153
Co,,\~ 0 6 lo>
C)
@TOTAL
Diversion Rate Achieved
Total of columns A + 8 + C
Contractor /Owner Signature ___ -=======::::::,;;;;;:=-------Date 15
Attach the following docu Return completed form and documentation to:
• Original recycling weight tic!< , andfill weight tickets
• Original donation receipts with photos and/or itemized descriptions
• Any other relevant information to support Recycling Report
City of Carlsbad
Building Division (1st Floor)
1635 Faraday Avenue
Carlsbad, CA 92008
Page 3 of 4 Rev. 041'22
PALOMAR TRANSFER
5960 EL CAMI NO REAL
CARLSBAD , CA 92008
(760)603-015J
000999 -CASH AND CHECK CUSTOMER
ADDRESS
carlsbad, CA 92008
Contract : 24 MINIMUM-CASH 2
GROSS
TARE
NET
Tracking Qty : 1.00
Qty Unit Description
1 . 00 EA MSW
Origin : CARLSBAD
Signature :
Scale In
Scale Out
100%
5 4 Ticket #: 2844903
Weighmaster: cantihy
In :
Out :
Vehicle :
Ref :
BOL :
INBOUND
CASH
May 19, 2025
May 19 , 2025
M23
Rate Extension Tax
$0 .00 $58 .00 $58 .00
Total
Paid
Change
.EDIT CARD-SCALE
3 :24 pm
3 :24 pm
Total
$58 .00
$58 .00
$58.00
$0 .00
V
PALOMAR TRANSFER STAT!
5960 EL CAMINO REAL
CARLSBAD, CA 92008
05,09/2025 12:32:16
Card /:I
O,ip Card:
AID:
SEQ 11 :
Batch ii:
INVOICE
Approval Code:
Entry Method:
Mode:
Tax .Amount:
I SALE AMOUNT
CREDIT CARD
VISA SALE
XXXXXXXXXXX.X9665
VISA DEBIT
A0000000031010
33
127
33
053215
Olp Read
Issuer
$0.00
$58.00
CUSTOMER COPY
PALOMAR TRANSFER
5960 EL CAMINO REAL
CARLSBAD , CA 92008
(760)603-0153
000999 -CASH AND CHECK CUSTOMER
ADDRESS ..
carlsbad, CA 92008
Contract : 24 MINIMUM-CASH 2
GROSS
TARE
NET
Tracking Qty : 1.00
Qty
1.00
Unit Description
EA MSW
Scale In
Scale Out
c,4 Ticket #: 2840971
Weighmaster : cantihy
In :
Out :
Vehicle :
Ref :
BOL :
May 09 , 2025
May 09 , 2025
M23
INBOUND
CASH
Rate
$58 .00
Extension
$58 .00
Tax
$0 .00
Origin: CARLS BAD 100%
Signature :
Total
Paid
Change
.EDIT CARD-SCALE
12 :32 pm
12 :32 pm
Total
$58 .00
$58 .00
$58 .00
$0 .00
V
PALOMAR TRANsffR STATJ
5960 a CAMTNO REAL
CARL5BAO, CA 92D0B
05 J9 2025 JS 25 07
C~dll
Olf)Cad
AID:
SEQ 11
Batdi #• I
INVOICE
A{JrxovaJ Code:
Entry Melhoo
f,bde_
Tax MmJt·
SALE AMOUNT
CREDIT CARD
VISA SALE
XXXXXXXXxxxx9665
VISA DEBIT
AOOOOOOoo 3 JO l 0
H
137
52
0725J8
Olf)R~
lS9.Jfr
$000
$58.00
CUSTOMER COPY
------------