A Debris Management Handbook for State and Local DOTs and Departments of Public Works (2014)

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H-1 A P P E N D I X H Debris Monitoring Tools (FEMA) LOAD TICKET Ticket No. 000001 Secon 1 Prime Contractor: Date: Subcontractor (Hauler): Departure Time: Driver: Truck Plate No.: Measured Bed Capacity (cu. yds.): Debris Pickup Site Locaon: (must be a street address) Debris Type: Vegetaon Construcon & Demolion Mixed Other: Loading Site Monitor: Print Name: Signature: Remarks: Secon 2 Debris Disposal Site Locaon: Esmate Debris Quanty: cu. yds. __________________ Arrival Time: Disposal Site Monitor: Print Name: ______________________________________________ Signature: Remarks: Copies: White – Load Site Monitor Green – Disposal Site Monitor Canary, Pink, Gold – Onsite Contractor’s Representave or Driver

H-2 A Debris Management Handbook for State and Local DOTs and Departments of Public Works Debris Loading Site Monitoring Checklist Date: ___________ Arrival Time: ___________Departure Time: ________Weather Condi ons: ______________ Loading Site Loca on: ________________________________________________________ (Street address or nearest intersec on) GPS Loca on: N_____________________________; W_______________________________ Loading Site Monitor's Name ____________________________________________________ (Print Name) Roving Monitor's Name: ________________________________________________________ (Print Name) __________________________________________________________ (Signature) Loading Site 1. Is the Site Monitor filling out the Load Ticket properly? YES NO If NO, explain ac ons taken: _________________________________________________________________________________ _____________ 2. Is the Contractor loading eligible debris from the designated right of-way (approximately 15' from curb)? YES NO If NO, explain ac ons taken: ________________________________________________________________________________ _____________ 3. Is the Contractor loading trucks to capacity? YES NO If NO, explain ac ons taken: ________________________________________________________________________________ ________________________________________________________________________________ 4. Iden fy Contractor's truck numbers observed while on site: _________;_________;________;________;_______;________;_______;_______;_____________ ________;_________;________;________;_______;________;_______;_______;____________ 5. Were photographs taken at the loading site? YES NO If YES, list photo log numbers: _________;_________;____________;____________;_________ General Notes and Comments: (Include observa ons within the general area as to overall cleanup ac vi es) _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _______________________________________________(Use reverse side if necessary)

Debris Monitoring Tools (FEMA) H-3 Debris Disposal Site Monitoring Checklist Date: ___________ Arrival Time: ___________Departure Time: ________Weather Condi ons: _______________ Disposal Site Loca on: _________________________________________________________ (Street address or nearest intersec on) GPS Loca on: N_____________________________; W_______________________________ Disposal Site Monitor's Name ____________________________________________________ (Print Name) Roving Monitor's Name: ________________________________________________________ (Print Name) __________________________________________________________ (Signature) Disposal Site 1. Is the Disposal Monitor filling out the Load Ticket properly? YES NO If NO, explain ac ons taken: ________________________________________________________________________________ ________________________________________________________________________________ 2. Is the Disposal Monitor aŒaching a copy of the Weight Ticket to the Load Ticket? YES NO If NO, explain ac ons taken: ________________________________________________________________________________ ________________________________________________________________________________ 3. Are the Contractor's trucks loaded to capacity? YES NO If NO, explain ac ons taken: ________________________________________________________________________________ ________________________________________________________________________________ 4. Iden fy Contractor's truck numbers observed while on site: _________;_________;________;________;_______;________;_______;_______;_____________ ________;_________;________;________;_______;________;_______;_______;____________ 5. Were photographs taken at the loading site? YES NO If YES, list photo log numbers: _________;_________;____________;____________;_________ General Notes and Comments: (Include observa ons of opera ons at the landfill) _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ ___________________________________________________________(Use reverse side if necessary)

Debris Monitoring Tools (FEMA) H-5