Contaminated 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

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 1828.2: Waste disposal categories - characteristics and thresholds*
- Yes
- No
Type of waste*
- Soil
- Sludges or slurries, including drilling muds

Domain/Area/Stockpile ID	Quantity

Category C/D Reportable Priority Waste Declaration Form