HomeMy WebLinkAbout1850 MARRON RD; 104; CBC2021-0481; RecyclePART 2 Complete before final inspection, obtain WASTE MANAGEMENT signature, and return with receipts prior to final
building approval.
DEBRIS RECYCLING REPORT (ACTUAL):
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 informati<Jn, and tt-~ the information is true and correct to the best of my knowledge
and belief.
Permit No. C{3l 2 02, \ -0~ 8 \ _Print Name
Address / KS Q N\4 UQ& Jl..9-
Use thl-Final LOP. be' , to track loads of materials as they leave the job site.
~SAVE RECEIPTS@@
Indicate FINAL quantities in !_fl!:~ . ,ch materi3: 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.
Date Material Type
A B C
Actual Amt
Reused or
Salvaged
Actual Amt
Recycled
Actual Amt
Disposed in
Landfill
Destination Facility
(Name, Address, Phone)
Example:
01/01/2020
Palomar Transfer Station, 5960 El
Concrete (broken) 5 tons
<l»TOTAL
Diversion Rate Achieved
columns A + B + C DIVERSION
Contractor/Owner Signature~~~~~~~....:'.::~"""==J----Date 6 -2,? ~ 2. 2,..
Attach the following docu Return completed form and documentation to:
• Original recycling weight ti ets, landfill weight tickets City of Carlsbad
• Original donation receipts with photos and/or itemized descriptions Building Division (1st Floor)
• Any other relevant information to support Recycling Report 1635 Faraday Avenue
Carlsbad, CA 92008
Page 3 of 4 Rev. 04122
ARTMENT )N
I .
:Go, CA92123-1636
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MIRAMAR LANDFILL
5180 CONvoy STREET
SAN DIEGO, CA 92111
37
Rernittance Nurnber: 0996
Las TONS -Gross Weight 13aao.oo
Tare Weight 101ao.oo
-Net Weight 3700.00 -
Tip F=ee
Spec Fee
CBus ti
Rec\lcl1
6.94
s.09 -1.85
s 72 .00
,$ 0
s 1s.oo s .2:>,.00
~ ~ s 109.,oo