CEW13 - Contaminated Soil Disposal Application Applicant Details Company Name*This field is required. * Required Field. Contact Person*This field is required. * Required Field. Address*This field is required. * Required Field. Telephone Number*This field is required. * Required Field. Alternate Contact Number Email Address*This field is required. * Required Field.* Please enter a valid email address. Waste Origin Details Origin of Waste*This field is required. * Required Field. Address waste originally came from Street Address:* * Required Field City:* * Required Field State:* * Required Field Post Code:* * Required Field Country: Select Country >> AUSTRALIA -------- AFGANISTAN ALBANIA ALGERIA AMERICAN SAMOA ANDORRA ANGOLA ANGUILLA ANTIGUA & BARBUDA ARGENTINA ARMENIA ARUBA AUSTRALIA AUSTRIA AZERBAIJAN BAHAMAS BAHRAIN BANGLADESH BARBADOS BELARUS BELGIUM BELIZE BENIN BERMUDA BHUTAN BOLIVIA BONAIRE BOSNIA & HERZEGOVINA BOTSWANA BRAZIL BRITISH INDIAN OCEAN TER BRUNEI BULGARIA BURKINA FASO BURUNDI CAMBODIA CAMEROON CANADA CANARY ISLANDS CAPE VERDE CAYMAN ISLANDS CENTRAL AFRICAN REPUBLIC CHAD CHANNEL ISLANDS CHILE CHINA CHRISTMAS ISLAND COCOS ISLAND COLOMBIA COMOROS CONGO COOK ISLANDS COSTA RICA COTE DIVOIRE CROATIA CUBA CURACO CYPRUS CZECH REPUBLIC DENMARK DJIBOUTI DOMINICA DOMINICAN REPUBLIC EAST TIMOR ECUADOR EGYPT EL SALVADOR EQUATORIAL GUINEA ERITREA ESTONIA ETHIOPIA FALKLAND ISLANDS FAROE ISLANDS FIJI FINLAND FRANCE FRENCH GUIANA FRENCH POLYNESIA FRENCH SOUTHERN TER GABON GAMBIA GEORGIA GERMANY GHANA GIBRALTAR GREAT BRITAIN GREECE GREENLAND GRENADA GUADELOUPE GUAM GUATEMALA GUINEA GUYANA HAITI HAWAII HONDURAS HONG KONG HUNGARY ICELAND INDIA INDONESIA IRAN IRAQ IRELAND ISLE OF MAN ISRAEL ITALY JAMAICA JAPAN JORDAN KAZAKHSTAN KENYA KIRIBATI KOREA NORTH KOREA SOUT KUWAIT KYRGYZSTAN LAOS LATVIA LEBANON LESOTHO LIBERIA LIBYA LIECHTENSTEIN LITHUANIA LUXEMBOURG MACAU MACEDONIA MADAGASCAR MALAYSIA MALAWI MALDIVES MALI MALTA MARSHALL ISLANDS MARTINIQUE MAURITANIA MAURITIUS MAYOTTE MEXICO MIDWAY ISLANDS MOLDOVA MONACO MONGOLIA MONTSERRAT MOROCCO MOZAMBIQUE MYANMAR NAMBIA NAURU NEPAL NETHERLAND ANTILLES NETHERLANDS NEVIS NEW CALEDONIA NEW ZEALAND NICARAGUA NIGER NIGERIA NIUE NORFOLK ISLAND NORWAY OMAN PAKISTAN PALAU ISLAND PALESTINE PANAMA PAPUA NEW GUINEA PARAGUAY PERU PHILLIPINES PITCAIRN ISLAND POLAND PORTUGAL PUERTO RICO QATAR REPUBLIC OF MONTENEGRO REPUBLIC OF SERBIA REUNION ROMANIA RUSSIA RWANDA ST BARTHELEMY ST EUSTATIUS ST HELENA ST KITTS-NEVIS ST LUCIA ST MAARTEN ST PIERRE & MIQUELON ST VINCENT & GRENADINES SAIPAN SAMOA SAMOA AMERICAN SAN MARINO SAO TOME & PRINCIPE SAUDI ARABIA SENEGAL SERBIA SEYCHELLES SIERRA LEONE SINGAPORE SLOVAKIA SLOVENIA SOLOMON ISLANDS SOMALIA SOUTH AFRICA SPAIN SRI LANKA SUDAN SURINAME SWAZILAND SWEDEN SWITZERLAND SYRIA TAHITI TAIWAN TAJIKISTAN TANZANIA THAILAND TOGO TOKELAU TONGA TRINIDAD & TOBAGO TUNISIA TURKEY TURKMENISTAN TURKS & CAICOS IS TUVALU UGANDA UKRAINE UNITED ARAB ERIMATES UNITED KINGDOM UNITED STATES OF AMERICA URAGUAY UZBEKISTAN VANUATU VATICAN CITY STATE VENEZUELA VIETNAM VIRGIN ISLANDS (BRIT) VIRGIN ISLANDS (USA) WAKE ISLAND WALLIS & FUTANA IS YEMEN ZAIRE ZAMBIA ZIMBABWE * Required Field Waste Carrier Details Company carrying the waste*This field is required. * Required Field. Contact Person*This field is required. * Required Field. Telephone Number*This field is required. * Required Field. Estimated Date of Delivery to Meru*This field is required. * Required Field. Multiple Loads*This field is required. YesNo If Yes, Delivery Period: * * Required Field. Type of Vehicle*This field is required. * Required Field. Payment Details Docket charged to*This field is required. * Required Field. Preferred method of payment*This field is required. CashEFTPOSACCOUNT If Account PO Number Waste Description Expected Total Tonnages*This field is required. * Required Field. What type of waste is it? Select an Option Liquid Solid Sludge Has the Laboratory Report been provided?*This field is required. YesNo * Required Field. How many samples were taken? Was a leachate test completed with laboratory report attached? YesNo Lab report info You will be required to attach copies of any Laboratory Reports at the end of this application before submitting. Contamination level determined by company How is the waste contaminated? Was the contaminated product remediated? YesNo If YES, with what product? Additional Comments Support Documentation Attach any Laboratory Reports:*This field is required. Max File Size: 10.00 MB Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .mov, .mp3, .mp4, .mpeg, .mpg, .pdf, .png, .ppt, .pptx, .xls, .xlsx Please Note Once the City of Greater Geraldton has reviewed this information (3-4 businesses days), we will determine what levels of contamination exist - various different classifications attract different disposal fees. To conform to our own internal auditing procedures, we may take samples of your product at the Meru Landfill site after disposal to verify the authenticity of any laboratory reports provided. Should higher levels of contamination exist, we may reject future waste disposal applications/levy an additional charge for rehandling the product. I have agreed to submit this application by electronic means. I can confirm that the information given in this application is true, complete and accurate. By checking this box and typing my name below, I am electronically signing my application.*This field is required. Please tick here Signature*This field is required. * Required Field. The City of Greater Geraldton collects the personal information you provide in relation to the Waste Disposal Application form so we can deliver the service, process your request, and meet our legal obligations under the Local Government Act 1995 and any other related legislation. Your information may be shared with government agencies, contractors, or others where authorised by law or with your consent. Where required by law, your personal information will be made publicly available, e.g. public registers. The City manages personal information in accordance with relevant privacy legislation and takes reasonable steps to protect it from unauthorised access or disclosure. You may request access to, or correction of, your personal information by contacting the City at privacy@cgg.wa.gov.au. Type the code from the image: The code you entered is not valid. Get Audio CodeType the code from the image Was this page helpful? How can we improve this page? Email Address*This field is required. * Required Field.* Please enter a valid Email Address Type the code from the image: Do not fill this textbox.