City of Oxnard

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					                                                                                           C&D Report
                                 City of Oxnard
              C&D Environmental Resources Management & Recycling
                          Report For Work Completed
  Form must be submitted and approved prior to issuance of certificate of occupancy.
        Date Submitted:_______                        _____Approved
                                                      _____Further Information Needed
                                                      _____Denied

                                                      Staff Initials:___________
 Applicant:

 Project Name:                                                  Project Number:

 Job Site:                                                      Total Square Footage of Project:

 Street Address:

 City, State, Zip:

 Project Manager:                             Signature of Person Completing Form:

 Phone:                                       Fax:                    Email:
 Cell Phone:
 Total Quantity of Material Diverted (reused, recycled):
 (See Other Side for C&D Report Worksheet)

 Total Quantity of Material Disposed (landfilled):
 (See Other Side for C&D Report Worksheet)



The California Integrated Waste Management Act of 1989, Assembly Bill 939, requires the City to divert
50% of waste generated from the landfills. Construction and Demolition (C&D) projects generate a
significant amount of material that can be recycled. In order to comply with AB939, the City requires
Applicant to minimize materials being landfilled by developing and implementing an Environmental
Resources Management & Recycling C&D Plan and documenting results in the Environmental
Resources Management & Recycling C&D Report.

After completion of construction and/or demolition, Applicant shall prepare an Environmental
Resources Management & Recycling C&D Report by completing the attached worksheet and by
providing legible copies of weigh tickets, receipts, or invoices for materials sent to disposal or
reuse/recycling facilities. For other discarded or salvaged materials, Applicant must provide
documentation, on letterhead, identifying where the materials were taken, type of materials, and tons or
cubic yards disposed, recycled or reused, and identify the project generating the discarded materials.
The Environmental Resources Management & Recycling C&D Report must be submitted and
approved prior to issuance of a certificate of occupancy.

Applicant shall also prepare an Environmental Resources Management & Recycling Occupancy
Plan. The Environmental Resources Management & Recycling Occupancy Plan must be
submitted and approved prior to issuance of a certificate of occupancy.




For additional information contact: Jay Duncan (805) 385-8059; fax 487-3860; jay.duncan@ci.oxnard.ca.us
                                                                                            C&D Report Form 07/08
ENVIRONMENTAL RESOURCES MANAGEMENT REPORT FOR COMPLETED WORK                                        Period Covered: __________ through __________   C&D REPORT
                                              Environmental Resources Management & Recycling Methods                 Project Name_______________________
1.   On-site concrete and asphalt crushing for use on-site                                5. Mixed recyclables hauled to recycling facility
2.   On-site concrete and asphalt crushing for use off-site                               6. Landfilled/Disposed
3.   On-site reuse other: mulching, chipping of greenwaste, etc.                          7. Other (Specify)
4.   Source Separation of materials hauled to recycling, composting, salvage, or other reuse facility
         Material                  Method #      Hauler/Self-Haul                 Destination               Actual Quantities          Description/Comments/
                                   (See Above)   (N/A if reused on site)        Facility/Location        Tons    Cubic Yd.    Units   Other/Weigh Tix Attached
Example: Cardboard                    4              self-haul             Del Norte Recycling/Oxnard              4                  Weight ticket attached
Asphalt
Brick/Tile
Cardboard
Carpet/Foam/Padding
Mixed Recyclables
(bottles, cans, etc.)
Concrete
Dirt (clean)
Drywall (new construction)
Glass/Plate/Window
Glass/Other
Green Waste: Yard
Trimmings, Trees,
stumps, etc.
Metals (Specify)
Paint
Rocks
Wood
Pallets
Other Salvage Material
Appliances
(water heaters, air
conditioners)
Cabinets
Doors
Drywall old
construction
Fixtures (shower stalls,
sinks, toilets, hardware, etc.)
Garage Doors
Mixed Trash
Other (describe)
     Add Additional Pages If Needed                                                    TOTAL
                                  For additional information contact: Jay Duncan (805) 385-8059; fax 487-3860; jay.duncan@ci.oxnard.ca.us
                                                                                                                                                    C&D Report Form 07/08

				
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posted:9/11/2012
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