Orinda, CA · Contra Costa County
Diversion Certification Request Form
This form requests recycling credit for construction and demolition materials delivered to unapproved facilities or reused or salvaged by Orinda project participants.
What this form is
The Diversion Certification Request Form documents construction and demolition debris or source-separated materials delivered to an unapproved facility, or materials reused or salvaged without a usual receipt. Both the delivering party and receiving facility, company, or individual complete and sign their sections. It asks for project and contact details, material type and amount, receipt date, and how received materials will be used.
Who needs it
Orinda project participants seeking recycling credit for materials taken to unapproved facilities or reused or salvaged without a usual receipt should complete this form.
How to submit it
Complete both sides, obtain both parties’ signatures, and include photos of the materials. Submit the form to the Construction Waste Management project in Green Halo during final submission to the City of Orinda.
About notarization
This form is signed and dated without a notary; it contains no notarized or sworn attachment, and both parties sign their respective sections.
How to submit this form
- 1
Download The Form
Download the Diversion Certification Request Form.
- 2
Complete Both Sections
The delivering party completes Part 1, and the receiving facility, company, or individual completes Part 2.
- 3
Gather Photos And Signatures
Include photos of the materials and have both parties sign and date their respective sections.
- 4
Submit Through Green Halo
Submit the completed form to the Construction Waste Management project in Green Halo during final submission to the City of Orinda.
Frequently asked questions
- What is the Diversion Certification Request Form used for?
- It requests recycling credit for construction and demolition debris or source-separated materials taken to an unapproved facility, or for materials reused or salvaged without a usual receipt.
- How do I submit the Diversion Certification Request Form?
- Complete and sign both sides, include photos of the materials, and submit the form to the Construction Waste Management project in Green Halo during your final submission to the City of Orinda.
- Do I need a notary for the Diversion Certification Request Form?
- No. This form is signed and dated without a notary; it contains no notarized or sworn attachment, and both parties sign their respective sections.
Need something notarized?
This Diversion Certification Request Form doesn’t need a notary — but if you have another Orinda form that does, a commissioned online notary can help.