Material Characterization Sheet
Please fill the information bellow when an Third-Party Hauler requests a LEED/Diversion Report at the Scale House
Date:
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Ticket Number:
*
Enter Ticket Number Here
Customer Information:
*
Customer Name / Name of the Hauler
Ticket #
Material Characterization:
Rows
Percentage % of the material in the load:
Metal
Wood
Asphalt/Concrete
Drywall
Roofing
Plastic
Cardboard/Paper
Styrofoam
Mattresses
Carpet
Organics
Other
Dirt
Total %
Must equal 100%
Picture of the load:
*
Click to take a picture
Cancel
of
Submit
Print Form
Should be Empty: