Pre-Receipt Site Assessment Form

Please complete this form to evaluate and identify the conditions and requirements of a site before receipt.


Principal Contractor/Occupier: Name	Customer Name: Name
Site Address: Address Previous History/Use of site: History Reports Attached?	Zoning: Industrial Commercial Domestic Greenfield
Soil Description:	Type: Type
Estimate Quantity: Quantity	Wet Top Soil Sub Soil Silt Clay Bedrock Dry
Evidence of Industrial Waste: Evidence	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: Name Signed By: Sign Date: 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: Site Inspected By: Name Date Received: Date Accepted or Rejected:

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: Site

Inspected By: Name
Date Received: Date

Accepted or Rejected:

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