HomeMy WebLinkAbout621 SYCAMORE ST - CORRESPONDENCE - 7/27/2017City
F6tof I c Community Development & Neighborhood Services
rCollins 281 N. College Ave. Fort Collins, CO 80522; Voice: 970-221-6760
FAX:970-224-6134
CONSTRUCTION WASTE MANAGEMENT PLAN and DOCUMENTATION
Note: City staff is able to assist if you have questions about implementing a construction site recycling program, please
call Jonathon Nagel at (970) 416-2701.
PROJECT INFORMATION
Address(es)
7,1 54e4rwer\e— 54.
Permit #(s) R I An i �F6 S—
General Contractor & Contact Info:
M
Instructions: Submit the construction waste management plan at the beginning and end of each project. At first
submittal, do not include the total volume/weights, hauler signatures or documentation. At project completion resubmit this
plan, with ALL fields completed, along with the required documentation. If one or more materials were not generated
during the project, indicate as such.
Documentation: Provide documentation from the hauling company listing the project address and services provided. If
you hauled the materials yourself, attach tickets from all facilities recycling the materials.
Material
Vendor hauling the
material
Facility recycling the
Total volume or weight
of material
Indicate if self -hauled
material
Indicate units
Concrete/Masonry
(Required)
Q«�/ I
Z— 1I0J5
Wood/Lumber
(Required)
1� I�(
EY�n�i✓\
ar�S tfVcl�ry�
Metals
(Required)'�
W ��R-0`Q1�lI
z �rtlCK IO�J
Cardboard
d)
Trash4:44
(5-q I)e
6$
N/A
Contaminated loads
(Intended recyclables, sent
N/A
;
to landfill. Indicate material)
I understand that my failure to follow this plan or resubmit this plan could include penalties of over $2,500 per
day of the violation and up to six months In tall. I certify that the above materials from my construction site were
recycled in the volume / weight described d were taken to the facilities described.
r,
K40 7-Z7- /7
Print Name & Signature - contracloror Owner Date
Print Name & Signature - Hauler(s) Date
(If multiple, indicate vendor and include signature from each)
Rev 6-1-2017
SCALE TICKET NO. Hageman Earth Cycle, Inc.
3501 E. Prospect Rd
Fort Collins, CO 80525
BUYER: -,-) t IVe-
COMMODITY:TONS:
REMARKS: ux SI-c .
SCALE FEE1 IS I
SCALE TICKET NO. Hageman Earth Cycle, Inc.
3501 E. Prospect Rd
Fort Collins, CO 80525
BUYER: i l V-e ►/ �l`.'V-aty n2-
COMMODITY: &J`I `34LL - UA/\. TONS:
REMARKS: Lk,)a
SCALE
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