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Home My WebLink About3554 - Diamond Bar - Self Haul Application - sent to Tara Reyes - 2025-06-26 bSELF HAUL APPLICATION C IT - DIAMOND BAR [. A[ I BAR H Y I A Self -hauling requires generator's own vehicles and equipment to transport waste to an approved facility. Please allow three (3) business days for review. Reporting template can be found on the back side of this application. SECTION 1: APPLICANT INFORMATION ❑ NEW ❑RENEW Applicant Name: David Watts Phone: 949 609-3517 Email Address: David.Watts@albertsons.com Business Name: Albertsons #3554 Business License #: Service Address: 1235 S.Diamond Bar Blvd Mailing Address (if different): I am the: ❑ Property Owner ❑ Tenant ❑ Contractor 0 Business Manager SECTION 2: MATERIALS TO BE SELF -HAULED Please check all that apply: Estimated Volume: 14.1 0 Recyclables ❑ cubic yards 0 tons 0 Organic Waste (landscape/food scraps/compostables) Hauling Frequency: 3/Week ❑ Solid Waste (regular household/ commercial) ❑ weekly 0 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: Albertsons Distribution Center Facility Address: 200 N. Puente, Brea, CA Material(s) Disposed: See Last Page Facility Phone Number: 714 671-6173 Email: David.Watts@albertson.con SECTION 4: VEHICLE INFORMATION Please list all vehicles used to transport materials. Attach additional pages if needed. Vehicle Make/Model: Albertsons Trucking Fleet Vehicle License Plate #: Registration Expiration: Insurance Provider: Insurance Expiration: Do you own or lease this vehicle? 0 Own ❑ Lease ❑ Authorized use Agreement SECTION 5: PERMIT FEE SCHEDULE Date Issued Fee January- March $1,024.89 April -June $769.00 July -September $513.12 October -December $255.89 CITY USE ONLY Permit #: Amount Paid: Exp Date: Date paid: Payment Method: 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 6/26/2025 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 Qt / 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 6/26/2025 Date Albertsons #3554 -1235 S. Diamond Bar BI. - Diamond Bar, CA, 91765 909 861-6207 ITEM Vendor Address City State Zip Contact Phone Cardboard NEW INDY 602 S. Rockerfeller Ave Ontario CA 91761 Demiciric Cooks 925 487-4405 Donations* Feeding America 161 N. Clark Street, Suite 700 Chicago IL 60601 Danielle Lawson 312 641-5384 X5408 Food Organics SMC Zero Waste 7325 Edison Ontario CA 92877 Sal Coco 951788-6042 Glass Misc. ALLAN Company 14620 Joanbridge Street Baldwin Park CA 91706 Samantha Hull 909 669-1796 Meat & Grease SMC Zero Waste 1600 W. Pellisier Rd Colton CA 92324 Sal Coco 951788-6042 Grease - Fryer RTI - Grease 16030 Carmenita Rd Cerritos CA 90703 Michelle Nicholso 951788-6042 Metal - Scrap SA Recycling 3200 E. Frontera St, Anaheim CA 92806 James Bandy 714-764-2234 Metal (CRV) containers ALLAN Company 14620 Joanbridge Street Baldwin Park CA 91706 Samantha Hull 909 669-1796 Paper/Mags/Books 4G Recycling 250 E. Parkcenter Blvd Deerfield Beac FL 33442 John Shandy 562 803-4401 Plastic - Corrugated Corr Industries 7215 N. 62nd Ave Glendale AZ 85301 Erika Nist 253 813-5340 Plastic (CRV) containers ALLAN Company 14620 Joanbridge Street Baldwin Park CA 91706 Samantha Hull 909 669-1796 Plastic Film & HDPE TREX 2375 E Newlands Dr Fernley NV 89408 Leland Arigoni 775 835-0200 Plastics C-Grade TREX 2375 E Newlands Dr Fernley NV 89408 Leland Arigoni 423 668-0111 Polystyrene (Styrofoam) Foam Zone Inc. 945 E. California St Ontario CA 91761 Gary Arnett 909 984-0902 Waxed Cardboard Newport CH International, LLC 1100 W. Town & Country Rd, Suite 1388 Orange CA 92868 Hamilton Wen 1714 -16-6700 Wood Puente Hills Recovery 13130 Crossroads Parkway Industry CA 91746 Cust. Service 1562 908-4288