HomeMy WebLinkAboutDISPOSAL RECEIPT.pdfCOUNTY SANITATION DISTRICTS OF LOS ANGELES
REFUSE DISPOSAL RECEIPT
FACILITY: PUENTE HILLS MRF
ACC6UNT4: ACCOUNT NAME:
LICEINSE#: 92485A3 CUSTOMER TYPE: Credit Card
REFUSE ORIGIN: 100.04 Diamond Ear
WE"IGHIN INFORMATION
TRANS,NUMEER; 901744810 W STATION : 1
TRANS,DATE : 11/02;`2023 W MASTER 305443
TIME IN 09:12:34 AM
GROSS WEIGHT: 9.77
TARE WEIGHT 4.14
NET WEIGHT 5.63
PRINTED DATE: 11, 02/2023
09:12:35 AN
REFUSE TYPE: Refuse
RATE: 93.99
SUBTOTAL; 529.16
TOTAL FEE; 529,16
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THIS RECEIPT IS VOID IF ANY HAND WRIT' -EN ENTRIES ARE CONTAINED
Each driver or payee is responsible for determining the accuracy on this receipt.
Any' questions or wron information should immediately be brought to the attention of the scale attendant
Max. unloading time* �o minutes.
8: ✓ City of D�nmond Bar
DIAMOND BAR
C,�{,oa IA (Con5truefl n & Demolition (C&D) Debris Plan
Required for all covered projects, 1,000 sq. ft or more. The deposit shall be returned, to the applicant, without
interest, in total or proportion upon submittal of proof that no less than 75% of the C&D was diverted.
Use of unauthorized waste haulers may also result in forfeit of the deposits.
Receipts and weight tickets can be submitted to: ereendb andiamondharea-cmv
Complete before obtaining a building, combination or demolition permit.
Submit this form and your deposit to the Building and Safety Division located at: 21S10 Copley Dr. Diamond Bar, CA. 91765
Applicant Contact Information-
,tt/
Name �-`ol t Title
Address :2 � Z 'A /A f4�`} (, �D r'
Phone-6-2— f r/ -- ` T i3.3,c�- Email
Project Information:
Permit No,
Project Address
Project Type: 0 New Construction 47 AdditionlAlteration
Building Type: ® Commercial ® Residential
Estimated Square Feet 9-0 O-P _
Estimated Start Date 0 _/�/ 23
Estimated Completion Date / ,Z Z / 23
Company
City O t t State .fir i Zip Q i
Zip i ( V
0 Demolition
TO DE FILLET] OUT BY CITY STAFF
"C&D De osit" Paid S ,z
Staff Initi _ Date Paid 3
3 i
FiR out the table with esthnated quantities in tons .for each material that will be generated by your project. Note; A + B = C
A B
Material Type Estimated Salvage,: Estimated
Reuse or Recycle 'Disposal (Trash)
C
Estimated Total
Debris (quantity
Applicant Self
I3att1 (check)
Certified Recycling
Facility or
Disposal Destination
Asphalt & Concrete
0.00
Brick / Masonry / Tile
0.00
Cabinets, Doors, Fixtures,
Windows (circle all that apply)
0.00
❑
Cardboard
Carpet, Padding / Foam
0.00
0.00
Ceiling Tile (acoustic)
0.00
Dirt
0.00
Drywall
GAG
Landscape Debris
0.00
Mixed C&D Debris
0.00
Mixed Inerts
Roofing Materials
0.00
0.00
0
Scrap Metal
0.00
Stucco
0.00
Unpainted Wood & Pallets
0.00
Garbage / Trash
0.00
Other:
0.00
TOTAL 0.00 0.00
0.00
To
Applicant Namei f ..11y
Rate: (Total A/Total C) x 10,0 = Recycling % .0.00%
Signature: -0
For information on construction and demolition waste management
Environmental Services at 909.839.7015 or via email to
-I-
ate: f r i
contact the City of Diamond Bar
09/28117