HomeMy WebLinkAboutQTRLY REPORT TEMPLATE FORMCity of Diamond Bar
Self-Haul Permit Quarterly Weight Ticket Report Instructions: Complete this form and email it to greendb@diamondbarca.gov with supporting
weight tickets. Submissions are required quarterly and must be submitted within 30 days after the
end of each quarter.
Deadlines are as follows:
• April 30 for Quarter 1 (January–March)
• July 31 for Quarter 2 (April–June)
• October 31 for Quarter 3 (July–September)
• January 30 for Quarter 4 (October–December)
Quarter: Year:
Date Ticket # Material Qty/ Vol (Unit) Destination Destination Address
Total: By signing below, I certify that the information in this report is true and accurate. I agree to follow
all applicable requirements under the Diamond Bar Municipal Code for self-hauling, including
properly separating recyclables and organics, using licensed disposal facilities, submitting
quarterly disposal reports with proof of disposal, maintaining safe and contained loads, and not
subcontracting hauling services.
Signature Date