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Fill Material Management
Non-contaminated Soil Declaration Form (Not Category C/D Reportable Priority Waste)
Soil will only be accepted by Repurpose It upon completion of this declaration form. We may contact you if we require further information.
We reserve our rights to reject material if it is considered unsuitable, including upon inspection at the weighbridge.
Waste Details and Declaration
Customer's company
*
Company whose account will be used at Repurpose It
Waste producer
*
Who/Which company has generated this waste
Waste transport company
*
Who/Which company is transporting the waste
Expected job start date
*
When will this material start being deposited at Repurpose It (If unknown please select approximate date)
DD slash MM slash YYYY
Expected job end date
*
When will this material cease being deposited at Repurpose It (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
*
If other, please provide more information below
Residential
Commercial / Industrial
Public space
Agricultural
Other
More information
If 'other' was selected
Current site use at waste source
*
e.g. factory, roadway, school, commercial shop, housing, etc.
Historic land use setting at waste source
*
If other, please provide more information below
Residential
Commercial / Industrial
Public space
Agricultural
Other
More information
If 'other' was selected
Activity which generated the waste
*
e.g. basement cut, preparation for site development, excavation for services removal/renewal, etc.
What material are you bringing to Repurpose It?
*
Mixed Fill (Fill Soil with Inert waste e.g. brick, concrete, etc.)
Clean Fill Soil with Rock
Clean Fill Soil with Vegetation
Sludges or slurries, including drilling muds (T130-NH)
Fill Soil (i.e. Raw Soil)
Mudstone
Estimated total quantity of waste proposed to be deposited at Repurpose It
*
Please enter a number
Estimated total quantity of waste proposed to be deposited at Repurpose It
*
Please select unit of measurement
Tonne
m3
Litre
Please provide any other details or a description of the material
e.g. Stockpile 1 – clean fill with rock, mixed fill with 25% concrete and bricks
Upload an image of your material (optional)
Accepted file types: jpg, jpeg, png, gif.
Is this material from a source that could potentially be considered contaminated?
*
e.g. landfill, petrol station, railway yard, factory, etc.
Yes
No
Has a Waste Classification Assessment been completed, or has the material been tested for contaminants?
*
Yes
No
If so, please provide the report(s)
*
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.
What solid inert waste is present in the material?
*
e.g. bricks, concrete, asphalt, bitumen, plastics, metals, none, etc.
Have there been any demolition works onsite?
*
Yes
No
Does this material contain Reportable Priority Waste (e.g. Category A, B, C or D) as defined by the Environment Protection Regulations 2021 and Environment Protection Act 2017?
*
Yes
No
Does this material contain asbestos?
*
Please note, Repurpose It cannot accept any Asbestos containing materials
Yes
No
Does the material contain any sign of contamination such as staining or odour?
*
Yes
No
Is this material classified as Waste Acid Sulphate Soil?
*
Yes
No
Please provide supporting evidence if available
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, Max. file size: 512 MB.
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.
• I have assessed this soil and I confirm that it does not contain Reportable Priority Waste (RPW) as defined by the Environment Protection Regulations 2021 and Environment Protection Act 2017.
• That this material does not contain asbestos.
• That Repurpose It maintains the right to reject any material that it deems unsuitable, including loads at the weighbridge.
• 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 RPW as per the Environment Protection Regulations 2021 and Environment Protection Act 2017.
• The indemnity includes, but is not limited to costs associated with plant and machinery, disposal fees, labour and loss of income through site closures.
I confirm I understand and agree to this declaration.
