4- Debris Recovery Statement.pdf

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Installation of Equipment- 13 Water Bottle Filling
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W91QF426BA009
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This is a Debris Recovery Statement form template for post-demolition and construction projects in Monterey County, California. The form requires contractors to document the disposition of all waste materials generated during demolition or construction activities and demonstrate compliance with a mandatory 60% waste diversion requirement.

The form captures project identification information including project address, contractor name, date, contact details, and project name. Contractors must categorize materials across 16 specified material types (asphalt, brick, cardboard, carpet, concrete, dirt/clean fill, drywall, metal, pallets, plastics, plant debris, roofing, clean wood, treated wood, and two additional material categories) and indicate for each whether materials were reused, recycled, or disposed. Contractors must identify the specific facility or service provider handling each material stream and document the weight in tons. For on-site reuse, contractors must describe the reuse application. The form requires attachment of supporting documentation including receipts, gate tags, or other verification evidence. The Material Generation Synopsis section requires calculation of total materials generated, total materials disposed, total materials salvaged/reused/recycled, and the overall recycling/reuse percentage (calculated by dividing salvaged materials by total materials generated). The form references the County of Monterey's Builders Guide to Reuse and Recycling website as a resource for jobsite material recovery assistance.

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SOW - 9

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:
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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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