4 - Debris Recovery Statement.pdf

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Installation of Equipment- 13 Water Bottle Filling Stations- AMENDMENT 02
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W91QF4-25-B-0001
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The document is a Debris Recovery Statement form used for tracking materials generated during post-demolition or construction projects. The form requires contractors to document the reuse, recycling, and disposal of various construction materials, with a mandatory requirement to recycle at least 60% of all waste generated. The form includes a comprehensive table for tracking materials such as asphalt, brick, concrete, metal, wood, and other construction debris, with columns for reuse, recycling, disposal, facility/service provider, and weight in tons. A Material Generation Synopsis section at the bottom allows calculation of total materials generated, disposed, and recycled, along with a percentage of materials recycled or reused. The form is dated 10 February 2021 and provides a reference link to a Builders Guide to Reuse and Recycling for Monterey County, California.

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Form Rev: 10 February 2021

DEBRIS RECOVERY STATEMENT – Post Demolition/Construction

Project Address: _____________________________________ Contractor: _________________________________________ Date: ______________________________________________ Contact: ____________________________________________ Phone: _____________________________________ ________ Email: _____________________________________________ Project: ____________________________________________

Identify which materials were reused, recycled or disposed by completing the table below. You must recycle at least 60% of all waste generated. Check the designated box and provide the name of each facility or service provider and weight of materials. If the materials were reused on site, describe the reuse application under the facilities/service provider column. Salvaged materials from deconstruction should be designated as reuse. Attach copies of receipts, gate tags, or other verifying documentation.

Material Reuse Recycle Dispose Facility Service

Provider Weight (tons)

Asphalt Brick Cardboard Carpet Concrete Dirt/Clean Fill Dry Wall Metal Pallets Plastics Plant Debris Roofing - asphalt composition shingle, tile, wood shake, tar or gravel

Wood - clean Wood - treated Other

Other

MATERIAL GENERATION SYNOPSIS

A. Total tons of materials generated for the project: _____________ B. Total tons of materials disposed (not recycled): _____________ C. Total tons of materials salvaged, reused, or recycled: _____________ D. Percentage of materials recycled/reused (divide C by A):_____________ %

For assistance in recovering materials at the jobsite, visit the following website for a Builders Guide to Reuse and Recycling for the County of Monterey, California.

https://www.co.monterey.ca.us/government/departments-a-h/health/environmental-health/recycling/construction-and-demolition-recycling

Project Address:
Contractor:
Date:
Contact:
Phone:
Email:
Project:
Other_2:
A Total tons of materials generated for the project:
B Total tons of materials disposed not recycled:
C Total tons of materials salvaged reused or recycled:
D Percentage of materials recycledreused divide C by A:
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