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Construction and Demolition Recycling Report <br /> Complete and submit this form within 14.days of project completion; including canceled projects. <br /> You must provide receipts and/or weight tags to verify;your.information. <br /> Permit#: 'S;c(gig Application Date: <br /> Job Site Address: 151{230_ Zip Code: 2.0 <br /> Applicant Name: Ildey ❑ Owner Contractor <br /> Applicant e-mail: ��✓r ! O Cit d Applicant Phone:20 3�d�✓ P <br /> '• <br /> Applicant AddresTltllo _ Y <br /> Project Name: Project Size (sq.ft.): <br /> Project Type: <br /> ❑Air Conditioning/Heating ❑ Constructior�Demolition F] Electrical E] Plumbing ❑ Roofing <br /> ❑ Sign Installation ❑ Solar Installation E] Swimming Pool (gOther: --�—UrL <br /> Tons Tons Taken To Method of Transport <br /> Material Type Recycled Disposed (receipts/weight tickets (Self-Haul,Site <br /> /Reused (landfill) must be attached Collection, Pick Up) <br /> ix <br /> Concrete I cement10 m� <br /> `5 47 Z <br /> Lumber/Wood <br /> Metals(AC,water heaters) <br /> Mixed construction mayterials I� �7 �ly�;G2,09 <br /> Roofing❑ composite ��JJ { <br /> Salvaged Items <br /> Other(please specify) <br /> Total Material <br /> If you have nothing to report, please explain: <br /> E-MAIL, FAX, OR MAIL COMPLETED RECYCLING REPORT TO: <br /> _,F <br /> YEC 'VED <br /> , <br /> _:mNVOONiU ENTAL. HEALTH <br /> PI, ?T -4 FIN`s' <br />