HomeMy WebLinkAbout621 SYCAMORE ST - CORRESPONDENCE - 10/26/2016 (3)Fort Collins
Community Development & Neighborhood Services
281 N. College Ave. Fort Collins, CO 80522; Voice: 970-221-6760
FAX:970-224-6134
CONSTRUCTION WASTE MANAGEMENT PLAN and DOCUMENTATION
Note: Environmental Services staff is able to assist with questions about getting a recycle program
implemented, and will also provide education and site visits upon request (call Caroline Mitchell at (970)
221-6288).
PROJECT INFORMATION
Address (o -{ t(j✓�/st�v''t'� (YE'G� Date /0",216 -Re
Permit No. g1(e0la�3S
General Contractor 8, Contact Info: }VLc� +�PlYt7 Eay► �}•7D— 1o�-DlQ9�
Material
Vendor hauling the
Facility recycling the
i`Totellvofume/;ortweI -ht'
material
materials
E of�materlat_� �;
Concrete/Masonry
Wood/LumberNIA
Metals
�j jpm 1I,01L
i
Cardboardrro+�r
Trash
N/A
Other (describe)
�a emSS[L�����
` �.� Pori Ra essyr•re.
��nR)) ��S.y_L/I
trod T�+W�flZl-1 I
Limn P L41dC� DWY•
_ fO '' �
A.AJ rnvlrys70F /O wis✓ow/g Wer-G ✓ wee oaJ4_d by Aetvamw c,by,yti,rsm 4.rie%&.ir4 H: vap 4ai.J
Required Documentation`: Provide signed documentation from the hauling company that the volumes & K.*#eAN
weights listed above are accurate. If you hauled the materials yourself, attach tickets from locations receiving e&W"INIJ
the recyclables. Documentation is required in order to receive final oroiect approval from the City. n"
'Y
I and my City -licensed hauler certify that the above materials from my construction site were recycled in the
volume / weight described and were taken to the facilities described.
Sigri�re (Contractor or Owner)
Date
/6
Date
'At minimum, the four listed materials must be recycled.
- Enter vendor name and phone number. If the applicant will haul the material themselves, state such.
'Where will applicant or vendor take the material for recycling? Enter facility name and address.
` To be completed at the end of the project. Please re -submit this form at end of project with these sections completed.
Rev I)15/14
B1606435
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WASTE MANAGEMENT •Weld LJndfill 7 1
WCR 215
AULTI CO,
Ph, (97113)
C4j (Al LU305'-�FANUM' !-,;;N I TF11 1 ON
C;.tst-omer Name Gbl GALLEGOS SANITATION I k M e
ticket Date II " 19 / 20 16; ner
Payment Type Credits Account D I
Manual Ticket#
hauling Ticket# ('h -k#
Route I -.5
titling 4
f.;
t5tate Waste. Code
Manifest Je GO 6
DoAt i n it i on
P13
Profile
Generator
und 56GU lb
Tine Scale Operator 'Inbo Tore 31700 lb
n It /19/20,16 12:2 Scale 4 BE
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Rat e. T t-4 m It Or i g i n
Product LD% Ot LIOM
MSWT—TONS 12.46 Tow;
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lot)) ticket
r.--' s SlonatueA�:A
61606435
0933293
., WABTfi MANAGNMBNT _
plor*th Weld Landfill
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Ph. t970i ��0
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Holding Ticket#
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Wiling #
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Mate'•Waste Code
Gen EPA in
ManYf est;
Destination
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7yi®p Seale uop-ator
it Crortnxt Gr"tfr?.t:;
in ..I1123/201,11 14;16.44 .^Cale 4,
31700 lb
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