Construction and Demolition Waste Reduction Report

Permit No. ______

RETURN THIS FORM AT PROJECT COMPLETION

CITY OF HERMOSA BEACH CONSTRUCTION AND DEMOLITION WASTE REDUCTION REPORT

NOTICE: A minimum of 65% of construction and demolition debris must be recycled for all newly constructed buildings and demolition in preparation for said new construction, and 50% of construction/demolition debris must be recycled for other projects.

Note: Athens Services is the City’s franchise waster hauler and can assist you with completing this form and recycling your construction debris. Call (888) 336-6100.

Owner Name: ______Date: ______

Property Address: ______

Owner Telephone: ______

Contractor Name: ______

Contractor Contact: ______Contractor Telephone: ______

Description of Project: ______

______

Approximate Dollar Value of Construction / Demolition: ______

Approximate Square Footage of Project: ______

Demolition Schedule: ______

Construction Schedule: ______

Name of Hauler(s): ______Telephone: ______

Please check waste reduction activities that are practiced at this project site:

___ Use of Prefabricated Components ___ Reduced Packaging ___ Reuse of Materials Onsite ___ Other (describe) ______Accurate Material Estimates ______

Permit No. ______

CONSTRUCTION AND DEMOLITION WASTE DISPOSITION SUMMARY

Fill out the tables below. The unit of measurement is “tons”. Use the conversion factors provided below. If a different conversion number is used, please provide. If tonnage information is not available, estimates can be provided in “cubic yards”.

Part I. DEMOLITION MATERIALS (tons or cubic yards) Material Disposed Taken to Other Reduced, How Diverted? Type in Class III Inert Fills Disposal Recycled or (e.g., reused as Landfill (describe) Salvaged aggregate, etc.) Concrete

Asphalt

Dirt

Wood

Metals

Mixed Waste

Other (describe)

Total A= B= C= D= Tons

Diversion Rate: D / (A+B+C+D) =

CONVERSION FACTORS Multiply by Number Below to Material Convert Cubic Yards to Tons Asphalt 1.0 Brick 1.2 Dirt 1.3 Wood 0.2 Gypsum Wallboard 0.2 Cardboard 0.02 Mixed Waste 0.9

Additional Notes / Comments:

2 Permit No. ______

CONSTRUCTION AND DEMOLITION WASTE DISPOSITION SUMMARY (cont.)

Part II. CONSTRUCTION MATERIALS (tons or cubic yards) Material Disposed Taken to Other Reduced, How Diverted? Type in Landfills Inert Fills (describe) Recycled or (e.g., reused as Salvaged aggregate, etc.) Concrete

Asphalt

Dirt

Wood

Metals

Mixed Waste

Other (describe)

Total Tons A= B= C= D= or Cubic Yards

Diversion Rate: D / (A+B+C+D) =

Additional Notes / Comments:

3 Permit No. ______

Disposal Facilities Please name of the facilities (e.g., landfill or inert facility name) materials are taken to:

______Facility Name Total Tons or Cubic Yards

Recycling Facilities Please name of the recycling facilities or recycler (materials given or sold to):

______Recycler / Recycling Facility Name Total Tons or Cubic Yards

MANIFESTS MUST BE ATTACHED SHOWING ALL DISPOSAL AT BOTH THE LANDFILL AND THE RECYCLING FACILITY

To the best of my knowledge, the above estimates are an accurate representation of the disposition of the construction and demolition materials generated on-site at the construction job. I understand that the City may audit disposal and recycling documentation related to this survey.

______Print Name Signature

Additional Notes / Comments:

Note: Athens Services is the City’s franchise waster hauler and can assist you with completing this form and recycling your construction debris. Call 888-336-6100.

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