Please complete this form to evaluate and identify the conditions and requirements of a site before receipt.
Principal Contractor/Occupier: | Customer Name: |
Site Address: Previous History/Use of site: Reports Attached? | Zoning:
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Soil Description: | Type: |
Estimate Quantity: |
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Evidence of Industrial Waste: | Color: |
I certify that I have undertaken an assessment of the materials being supplied in accordance with the IWRG 621 Soil Hazard Categorization and Management. | Inspected By: Signed By: Date: |
Approved Clean Fill Receipt (Receiver) I confirm that I have received and read this assessment. The site assessment states that the materials is Clean Fill. I have also inspected the material before accepting it and see no evidence that other wastes are mixed in the load and did not detect any odor. Fill Site: Inspected By: Accepted or Rejected: |
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