HomeMy WebLinkAboutSELF HAUL APPLICATION & REPORTING TEMPLATESELF HAUL APPLICATION
Self-hauling requires generator’s own vehicles and equipment to
transport waste to an approved facility. Please allow three (3)
business days for review. Please email greendb@diamondbarca.gov.
SECTION 1: APPLICANT INFORMATION ☐NEW ☐RENEW
Applicant Name: Phone:
Email Address:
Business Name: Business License #:
Service Address:
Mailing Address (if different):
I am the: ☐ Property Owner ☐Tenant ☐Contractor ☐Business Manager
SECTION 2: MATERIALS TO BE SELF-HAULED
Please check all that apply: Estimated Volume:
☐Recyclables ☐cubic yards ☐tons
☐Organic Waste (landscape/food scraps/compostables)Hauling Frequency:
☐Solid Waste (regular household/ commercial)☐weekly ☐monthly
☐Construction/ Demolition Waste
SECTION 3: DISPOSAL/RECYCLING FACILITY INFORMATION
Please list all facilities where materials will be transported. Attach additional pages if needed.
Facility Name:
Facility Address:
Material(s) Disposed:
Facility Phone Number: Email:
SECTION 4: VEHICLE INFORMATION
Please list all vehicles used to transport materials. Attach additional pages if needed.
Vehicle Make/Model:
Vehicle License Plate #: Registration Expiration:
Insurance Provider: Insurance Expiration:
Do you own or lease this vehicle? ☐ Own ☐ Lease ☐ Authorized use Agreement
SECTION 5: PERMIT FEE SCHEDULE CITY USE ONLY
Date Issued Fee Approved By: Date:
January- March $1,024.89 Permit #:
April-June $769.00 Amount Paid: Date paid:
July-September $513.12 Payment Method:
October-December $255.89 Buildings Staff Initials:
I understand and agree to follow all requirements of the Diamond Bar Municipal Code related to self-
hauling and solid waste disposal. This includes properly separating recyclables and organics as required
by local and state regulations, using only licensed disposal facilities, submitting quarterly disposal reports
with supporting receipts or weight tickets, ensuring vehicle safety and secure loads, not subcontracting
hauling services, and renewing this permit each year. I acknowledge that failure to comply with these
requirements may result in the revocation of my self-haul permit.
Signature Date
City 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