Opt-Out of Debris Removal on Private Property

Who needs to complete this form? Property owners with destroyed structures identified by a government agency who elect not to participate in the Government-run debris removal program (Program) and choose to clean up their property on their own, or with a qualified contractor OR properties that do not qualify for the Program. The work must be done to standards established inordinances and regulations so that health and safety risks are adequately addressed for the community and the environment. Documentation on adequate cleanup and proper disposal will be required including US EPA Phase I clearance. Federal/State disaster funding will not be able to reimburse for this work.

Property Information

Property Owner Name*

Email*

Phone*

Phone

Property Address*

City*

Assessor's Parcel Number (APN)

Need help finding your APN? Visit the Assessor - Property Search page at https://assessor.lacounty.gov/homeowners/property-search

Mailing Address

Address*

City*

State*

Select

Zip Code*

Debris Removal Requirements

Phase I clearance from USEPA or USACE, approval from the County, and a permit from the applicable local authority is required prior to starting debris cleanup. There are specific licensure and certification requirements for the Prime contractor to obtain the Fire Debris Removal Permit. For additional information please follow this link: Property Owner Guide to Select Certified Contractor for Opt-Outs.pdf

Description of Debris Being Removed*

How many structures, type of waste, etc.

Who Will Perform the Debris Removal?

Name of Contractor

License Number

Proposed Start Date

Property Owner Acceptance

Acknowledgement & Signature*

I understand that I will have to follow the protocols outlined in the “Management of Los Angeles County Wildfire Debris” document and specifications for private debris removal. I agree that the appropriately licensed contractor(s) that will perform the work in accordance with the work plans that demonstrate that the standards and requirements established for the Local Program are met. I understand the ash and debris shall be wetted down prior to removal and dust shall be controlled. The ash and debris shall also be completely encapsulated with a tarp ("burrito wrap" method) prior to being transported for disposal.

Please type your full name in the box below. By entering your name, you are acknowledging that this serves as your digital signature and confirms your agreement with the information provided.

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