CEW13 - Waste 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 Address waste originally came from Company Name disposing waste Contact Person Telephone Number Waste Carrier Details Company carrying the waste Contact Person Telephone Number Client Multiple Loads YesNo Type of Vehicle Proposed Disposal Date - Phone CGG office prior to delivery and give details. Contact Person responsible for waste Contact Person Telephone Number Waste Description Estimated Date of Delivery Expected Total Tonnages What type of waste is it? Select an Option Liquid Solid Sludge Has the Laboratory Report been provided? YesNo How many samples were taken? Was a leachate test completed with laboratory report attached? YesNo 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? Where is the product currently stored? How is the product currently stored? How long have you had the product in storage? 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 Geradton has reveiwed 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 interal 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 pris@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.