CITY OF DOWNEY - CONSTRUCTION & DEMOLITION WASTE ...

CITY OF DOWNEY - CONSTRUCTION & DEMOLITION
WASTE MANAGEMENT PLAN - COMPLIANCE REPORT
FORM B – Page 1 of 2
DATE OF SUBMITTAL: _____________________
BUILDING PERMIT #: ____________________
PROJECT COMPLETION DATE: ______________
APPLICANT NAME: __________________________________________________________________
COMPANY NAME: ___________________________________________________________________
PROJECT ADDRESS: _________________________________________________________________
This entire form must be completed and submitted to the City of Downey within 30 days
following the completion of the project. FAILURE TO SUBMIT THIS FORM could be cause
for surrender of deposit, non- issuance of final project approval, and delay of issuance of
construction and/or demolition permits for site development.
Originals of all receipts and weight tags from recycling facilities,
Salvage companies, deconstruction contractors, haulers, processors,
Transfer stations, and landfills MUST be attached to this report.
Applicants are required to recycle 100% of all inert debris and
at least 50% of the remaining C&D debris
Complete and submit to:
City of Downey
Public Works / Engineering
Attn: WMP Compliance Officer
11111 Brookshire Avenue
Downey, CA 90241
City Hall Office Hours:
7:30 a.m. – 5:30 p.m.
Tele: (562) 904-7110
FAX: (562) 904-7296
I, the undersigned, am authorized to sign on behalf of the applicant, and hereby acknowledge the requirements
of Chapter 8, Ordinance No. 07-1217, of the Downey Municipal Code relating to the diversion of Construction
and Demolition waste. I attest that all information presented on Form B, pages 1 and 2, is true and accurate.
Applicant Signature__________________________ Print Name__________________________ Date ________
FOR CITY USE ONLY Diversion: Inert _________% Other C&D_________%
Deposit to be returned? Yes_____ No_____ □ Compliant □ Good Faith □ Non-Compliant
Deposit Amount $___________________ Date__________
(Form continued)
_______________________________________________________________
__________________________
By________________________________________________ FINAL APPROVAL - WMP COMPLIANCE OFFICER DATE

CITY OF DOWNEY - CONSTRUCTION & DEMOLITION
WASTE MANAGEMENT PLAN - COMPLIANCE REPORT
Material
* Asphalt
1 cy = 1,380 lbs
* Brick
1 cy = 3,024 lbs
Building materials
(ceiling tile, doors,
fixtures, windows, etc.)
Cardboard, Paper
1 cy = 100 lbs
Carpet & Padding
1 cy = 84.4 lbs
* Concrete
1 cy = 1,855 lbs
Dirt
10 cy = 18,900 lbs
Glass
1 cy = 2,160 lbs
Green Waste
40 cy = 4,320 lbs
Gypsum/Dry Wall
1 cy = 3,834 lbs
Metals
1 cy = 906 lbs
Mixed C&D
(commingled,
recyclable)
Plastic
1 cy = 22.55 lbs
* Rock, Gravel
Recycled
(tons)
Reused
(tons)
FORM B – Page 2 of 2
Disposed
(tons)
Total
Quantity
Generated
Facility Used / Destination of Material
Roofing Material --- ---
Stucco
* Tile, Stone
1 cy = 1,214 lbs
Wood
(lumber, doors, etc.)
1 cy = 329.5 lbs
Refuse N/A N/A
Other
TOTALS
* Fill in the blanks to determine if you have diverted 100% of the INERT MATERIAL: (Inerts marked *)
Recycled _______ + Reused _______ = ________ ÷ Total Quantity Generated _______ =_______ x 100 =_______%
Fill in the blanks to determine if you have diverted at least 50% of the remaining material:
Recycled _______ + Reused _______ = ________ ÷ Total Quantity Generated _______ =_______ x 100 =_______%