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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
*
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 select what waste material you propose to bring 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.
Clean NDD
Fill Soil (i.e. Raw Soil)
Mudstone
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
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
I confirm that the source of this soil is not contaminated land
*
e.g. current or former industrial site, railway yards, utility depot 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, Max. file size: 512 MB.
I confirm that this material does not 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
I confirm that this material does not contain asbestos
*
Yes
No
What solid inert waste is present in the material?
*
e.g. bricks, concrete, asphalt, bitumen, plastics, metals, none etc.
Has there been any demolition works onsite?
*
Yes
No
I confirm that the soil is free of visual contamination such as staining or odour.
*
Yes
No
I confirm that the waste does not contain 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:
*
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.
• 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.
