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Contaminated Declaration Form
Category C/D Reportable Priority Waste Declaration Form
Soil will only be considered by Repurpose It upon completion of this declaration form. We may contact you if we require further information when reviewing your request. Please allow a minimum of one to two business days for approval.
We reserve our rights to accept or reject material upon final inspection at the weighbridge.
Waste Details And Declaration
Customer's company
*
Company whose account will be used at Repurpose It
Waste producer
*
Waste transport company
*
Expected job start date
*
i.e. Delivery to Repurpose It will start. If unknown please select approximate date
DD slash MM slash YYYY
Expected job end date
*
i.e. Delivery to Repurpose It will cease. If unknown please select approximate date
DD slash MM slash YYYY
Contact name
*
Contact email address
*
Contact phone number
*
Hidden
Address of waste source
*
Address of waste source
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Current land use setting at waste source
*
Residential
Public space
Commercial / Industrial
Current site use at waste source
*
e.g. factory, roadway, school, commercial shop etc.
Historic use at waste source
*
e.g. residential, factory, commercial shop, industrial facility, chemical manufacturing, gasworks, service station etc.
Activity which generated the waste
*
e.g. basement cut, preparation for site development, excavation for services removal/renewal etc.
Please upload the Waste Classification Assessment
*
NOTE: If you can see your file name, it means you have successfully uploaded your file. The red cross on the left is just to delete the file.
Drop files here or
Select files
Accepted file types: pdf, doc, docx, png, jpg, gif, xlsx, zip, Max. file size: 512 MB.
I have provided a Waste Classification Assessment, including NATA accredited laboratory report/s completed in accordance with EPA Victorian Publication IWRG702: Soil Sampling and EPA Victoria Publication 1828: Waste disposal categories - characteristics and thresholds
*
Yes
No
Type of waste
*
Soil
Sludges or slurries, including drilling muds
Please select the appropriate option below, as per EPA Victoria Publications 1828 and IWRG822, for waste proposed to be deposited at Repurpose It.
*
Category D Soil Reportable Priority Waste (N120)
Category C Soil Reportable Priority Waste (N120)
Sludges or slurries, including drilling muds, containing hazardous substances (T130-H)
Waste Acid Sulfate Soil (WASS) (N123)
Category C/D Soil Reportable Priority Waste with WASS (N120)
Can select multiple options if applicable.
Please specify the domain/area/stockpile and approximate quantity of waste proposed to be deposited at Repurpose It. Please state whether quantity is in m3 or tonne
*
Domain/Area/Stockpile ID
Quantity
Estimated total quantity of waste proposed to be deposited at Repurpose It (Enter number)
*
Estimated total quantity of waste proposed to be deposited at Repurpose It (Select metric)
*
Tonne
m3
Litre
I confirm that this material does not contain asbestos
*
Yes
No
Does the waste contain any of the following? (Non-ferrous metals, Organic waste, Settlement dam silt, Tyres)
*
Yes
No
Hidden
I confirm that the waste does not contain waste acid sulphate soils.
*
Yes
No
Declaration:
*
I confirm I understand and agree to this declaration.
By submitting this form I declare and confirm the following:
• That the information I provided in this declaration form is true and accurate.
• That I am the waste producer or have been appointed by the waste producer to manage the waste described in this declaration form.
• That all waste to be deposited at Repurpose It will come solely from the nominated address and specific stockpiles/domains specified in this declaration form.
• This soil has been classified by the waste generator as Category C and/or Category D Reportable Priority Waste (RPW) in accordance with Regulation 66 of the Environment Protection Regulations 2021. Evidence supporting the classification is attached to this declaration form.
• That this material does not contain asbestos.
• That waste classified as Category A or Category B RPW, waste containing asbestos, or any other waste other than Category C and Category D RPW will not be deposited at Repurpose It.
• That Repurpose It maintains the right to reject any material that it deems unsuitable, including loads at the weighbridge.
• That every load of Category C and Category D RPW will be accompanied by an EPA Waste Record ID.
• The waste producer indemnifies the transporter and the receiver against all costs the transporter or receiver may incur because of needing to remove materials that do not meet the definition of Category C or Category D RPW as per the Environment Protection Regulations 2021 and Environment Protection Act 2017, or waste containing asbestos.
• The indemnity includes, but is not limited to costs associated with plant and machinery, disposal fees, labour and loss of income through site closures.
