Submit to Community
Development
City of Arcata Construction/Demolition Waste Management
Final Diversion/Disposal Report
Use this form upon completion of the project to report: 1) Total project waste; and 2) Final amounts of
materials reused, recycled, otherwise diverted and disposed
Project_______________________ Permit #_____ Location____________________
Date___________________________ Contractor’s Name______________________
Phone__________________
Email___________________________
I. Total Project Waste
Quantity (tons)
Landfill site
Tip fee/ton
$
Total cost of
disposal*
$
Total cost/ton
$
*includes hauling, container rental & tip fee– Submit receipts for proof of materials diverted/disposed
II. Quantity and Cost for Materials Reused, Recycled or otherwise Diverted
Please
Circle
Type of Work: CONSTRUCTION
DEMOLITION
Example: Brick; Masonry; Tile; Cinderblock
Asphalt
Bath Fixtures
Brick; Masonry; Tile; Cinderblock
Cardboard
Carpet; carpet padding
Ceiling tile (acoustic)
Concrete
Containers – bottles and cans
Dirt – (must be wet down for Kernen)
Doors – Storefront, hollow, solid
Drywall (new, unpainted sheets or scrap)
Drywall (used)
Electric Panels
Furnaces/Water heater
Green waste – brush, tree trimmings, stumps
Metal – scrap, rails, metal siding, etc.
PVC pipe
Roofing; Roof shingles
Trash – non-recyclable material
Windows and window framing/Glass
Wood & pallets – unpainted
0.25 (500 lb)
Self
Haul
Arcata
Garbage
Savings If
Recycled
(Dollars)
Disposal
Costs
(Dollars)
Cost of
Handling
&
Transport
(Dollars)
(Pounds)
MATERIAL TYPE
QUANTITY
TRANSPORT
x
Environmental Services Dept. Approval: ___________________Date:____________
III. Total net cost (+) or savings(-) from all alternatives to landfill disposal of all
project waste
IV. Means of keeping recyclables free of contamination:
V. Meetings to be held to address waste management: