Nevada County Self-Haul Reporting Form

Nevada County | Self-Haul Reporting Form
Assembly Bill (AB) 341, Assembly Bill (AB) 1826 and Senate Bill (SB) 1383 allow commercial solid waste generators who do not subscribe to recycling and/or organics service with the franchised hauler to provide proof of compliance with AB 341, AB 1826 and SB 1383. Proof includes, but is not limited to, all receipts from recycling and/or organics processing facilities that clearly identifies the type and quantity of material delivered. Records demonstrating proof of compliance must be retained at your place of business and per County Code Sec. G-IV 8.13 D, provided to the County within 60 days of request.

Accordingly, please submit this form by February 1st of each year.
Company Name
Business Type
Main Point of Contact Name
Title
Number of Employees/Tenants
Phone
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Identify the types of recyclable materials and/or organic materials to be self-hauled or back-hauled and annual total volume in pounds, tons or units for the prior calendar year (please identity volume measurement used). Examples of recyclable materials include cardboard, plastic bags, film, hard plastics, cans, bottles, green waste, and food waste. Please also include donated items, including donations of edible food.

Please list destination facility information below for each material type(s):
Material Type 1
Material Disposition

CardboardPlastic bagsFilmHard plasticsCansBottlesGreen wasteFood wasteDonated itemsOther
Annual Volume
Quantity of Unit
Annual Volume Unit
January 1 - December 31
Name of Facility
Facility Address
Material Type 2
Material Disposition

CardboardPlastic bagsFilmHard plasticsCansBottlesGreen wasteFood wasteDonated itemsOther
Annual Volume
Quantity of Unit
Annual Volume Unit
January 1 - December 31
Name of Facility
Facility Address
Material Type 3
Material Disposition

CardboardPlastic bagsFilmHard plasticsCansBottlesGreen wasteFood wasteDonated itemsOther
Annual Volume
Quantity of Unit
Annual Volume Unit
January 1 - December 31
Name of Facility
Facility Address
Material Type 4
Material Disposition

CardboardPlastic bagsFilmHard plasticsCansBottlesGreen wasteFood wasteDonated itemsOther
Annual Volume
Quantity of Unit
Annual Volume Unit
January 1 - December 31
Name of Facility
Facility Address
Material Type 5
Material Disposition

CardboardPlastic bagsFilmHard plasticsCansBottlesGreen wasteFood wasteDonated itemsOther
Annual Volume
Quantity of Unit
Annual Volume Unit
January 1 - December 31
Name of Facility
Facility Address
If you have more Material to report, please submit an additional form.
Attachments

Cancelof
By checking the box below, I agree to comply with the requirements of State Law and will deliver recyclable materials and organic materials generated to permitted facilities for processing and not disposal or use as Alternative Daily Cover. I certify that all self-hauling activities will be completed in accordance with all applicable laws or regulations.

I agree to comply
Print Name
Date

MonthDayYear
Date
Should be Empty:

Nevada County | Self-Haul Reporting Form

Material Type 1

Material Type 2

Material Type 3

Material Type 4

Material Type 5