HomeMy WebLinkAbout1978-2021DocuSign Envelope ID: 5CB82389-04EA-42FF-B596-A3DC95D199DF
CONSTRUCTION & DEMOLITION RECYCLING PLAN and DISPOSAL REPORT
City of San Luis Obispo Utilities Department 879 Morro Street, San Luis Obispo, CA 93401 805-781-7215
Please read this form carefully. The goal is to clearly document thatyou have recycled a minimum of 65% of C&D materials, per California State regulations.
Prior to Project: Completely fill out Section 1 and Section 2 (if applicable).
Section 1: To be completed by all Building Permit Applicants
Application Number: Site Address: Type of Project:
Hiquera Street Tenant Improvement - Cannabis Retail
Owner's Name: Contractor's Name Square Footage:
Stephan Kennedy 4829
1,000,000
Using a Certified Roll -Off Company exclusively? Y / N Self -Hauling? Y / N YES Estimated Fine for Failure to Comply (2% of total EPC):
4,000
IF YES, WHICH ONE?
IF YES, COMPLETE SECTION 2.
Applicant's Name: (Printed) (Signed) Date:
Stephan Kennedy 7/12/2022
Section 2: To be completed if self -hauling.
If self -ha ling, lease list the recycling facilities where the waste will be taken.
Concrete and Asphalt: Wood: Santa Maria Transfer station Cardboard: Santa Maria Transfer station
Gator Crushing and Recycling or Chicago Grade and landfill - Atascadero or Chicago Grade and landfill - Atascadero
Drywall: Santa Maria Transfer station Metals: Santa Maria Transfer station Other: Santa Maria Transfer station
or Chicago Grade and landfill - Atascadero or Chicago Grade and landfill - Atascadero
I understand that I must produce receipts listing tonnage of all materials
leaving the project site, regardless of destination or method of removal.
l certify that I will communicate this plan and requirements to all
contractors and other personnel who may be involved in disposal of
materials from this project, and inform them that they must provide
receipts for all recycling and trash disposal.
The final permit and all waste receil2ts must be presented prior to final
sign off. I understand that failure to do so may incur a penalty of 2% of
total project valuation.
7/13/2022
Sign) (Date)
ALL TONNAGE LEAVING SITE MUST BE ACCOUNTED FOR
ON THIS FORM
FAILURE TO RECYCLE AT LEAST 65% OF MATERIALS CAN
RESULT IN A PENALTY OF 2% OF PROJECT VALUATION
For Utilities Office Use Onlv
Plan Approved: Reviewed/Approved by:
Project Exempt:
of
7
Plan Denied: Date: L