HomeMy WebLinkAboutWM Receipt for City of Diamond Bar (2).pdfAzusa Land Reclamation Original
1211 W. Gladstone St. Ticket# 1443989
uvn7�M,1NIANACaEfoEeu-e Azusa, CA, 91702
Ph: 626-224-9127
Customer Name BUSINESS -COD BUSINESS -COD
Ticket Date 09/10/2024
Payment Type Credit Card.
Manual Ticket#
Hauling Ticket#
Route
State Waste Code
Manifest 239 N PALO CODRO
Destination
PO
Profile { }
Generator
Carrier CAL STATE ROOFING
Vehicle# 4 Volume
Container
Driver
Check# MC0836
Billing 4 0002070
Gen EPA ID
Grid
Time
Scale
Operator
Inbound Gross
24400 lb
In 09/10/2024 11:48:32
Scale 2
LSANCHE4
Tare
10980 lb
Out 09/10/2024 11:48:32
LSANCHE4
Net
13420 lb
Tons
6.71
Comments
Product
LD% Qty
UOM Rate
Tax Amount
Origin
--_----------____----------------------------------------
1 CCLN-TON-CLEAN CON
100 6.71
-
Tons 23.95
$191.60
Diamond Ba
2 ENERGY -Energy Surc
100
% 6.00
$11.50
Diamond as
Amt $203.10, Amt Tendered $203.10, Chg Due $0.00
Total Tax
Total Ticket $203.10
Driver's Signature
City of Diamond Bar
DIAMOND BAR Construction &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 weip-ht tickets can be submitted to: 2reendb(iMamondbarca.2ov
Complete before obtaining a building, combination or demolition permit.
Submit this form and your deposit to the Building and Safety Division located at: 21810 Copley Dr. Diamond Bar, CA. 91765
Applicant Contact Information:
Name Robert Perez
Title owner Company
Address 135 Clearview Crest Dr.
City Diamond Bar State CA zip 91765
Phone 9094555609
Email R2BUYNSELLPROP@AOL.COM
Project Information:
1ndicate WasteHauler
Permit No. PR24-0669-ZA/alley
Vista WM 62]-Gelf-H-atfl-
Project Address 135 Clearview Crest Dr.
zip 91765
Project Type: 0 New Construction O Addition/Alteration N Demolition
Building Type: CJ Commercial i& Residential
Estimated Square Feet 3000
TO BE FILLED OUT BY CITY STAFF
Estimated Start Date 71112Q24 / 1
"C&D Deposit" Paid $ 300.00
Av
Staff Initials Date Paid 4
911 /2024
Estimated Completion Date 1
I
Fill out the table with estimated quantities in tons for each material that will be generated by your project. Note: A + B = C
A
B
C
Applicant Self
Certified Recycling
Material Type
Estimated Salvage,;
Estimated
Estimated Total
Haul (check)
Facility or
Reuse or Recycle
? Disposal (Trash)
Debris Quantity
Disposal Destination
Asphalt & Concrete
0.00
Brick 1 Masonry / Tile
D_00
--R
Cabinets, Doors, Fixtures,
0.00
❑
Windows (eirele an dig apply)
Cardboard
0.00
Carpet, Padding I Foam
0.00
Ceiling Tile (acoustic)
0.00
Dirt
0.00
Drywall
0.00
Landscape Debris
0.00
Mixed C&D Debris
0.00
Mixed Ineris
0.00
Roofing Materials
: 6.00
6.00
✓
Scrap Metal
0.00
Stucco
0.00
Unpainted Wood & Pallets
0.00
Garbage / Trash
0.00
Other:
0.00
TOTAL
10.00
6.00
16.00
To estimate Recycling Rate: (Total A/Total C) x 100 = Recycling % 0.00%
Applicant Name: Robert Perez
Signature: fl obert Perez J Date: 6/6/2024�
For information on construction and demolition waste management plans contact the City of Diamond Bar
Environmental Services at 909.839.7015 or via email to greendb@diamondbarea.gov
- 1 - 09/28/17