Pre-Accceptance Form for Inert Waste Please complete the form below (Please note ALL fields MUST be completed) Reference No: (required) Waste Producer: Full Company Name: (required) Full Company Address: (required) Postcode: (required) Contact Name: (required) Telephone Number: (required) Email: (required) Waste Carrier: Full Company Name: (required) Full Company Address: (required) 266 Bolton Road, Aspull, Wigan Postcode: (required) Contact Name: (required) Telephone Number: (required) Email: (required) Form completed by: (required) Waste ProducerWaste Carrier Estimated volume of waste (choose most appropriate units): (required) LoadsTonnesCu Metres Disposal Date (commencement): (required) Full Address of Source of Waste: (required) Postcode: (required) Process from which waste arises: (required) Description and/or composition of Waste (as detailed as possible): (required) EWC Code: (required) SIC Code: (required) For Inert Waste - details of existing and / or previous use of site (where known): (required) Is there an odour?: (required) YesNo Please describe odour: (required) Does the waste contain any biodegradeable material?: (required) e.g. Wood/Paper/Grass, etc YesNoDon't Know Please describe biodegradeable material: (required) Are chemical analyses available?: (required) YesNo Please submit the test data: (required) Reason why analysis is not required?: (required) Proposed Disposal Site(s): (required) I confirm that, to the best of my knowledge, the material that I wish to deposit is inert waste, I fully understand that your landfill site is only authorised to accept inert waste and that, if either by visual inspection or by random sampling, the waste covered by this waste information form exceeds the site limits, I will be responsible for all costs involved in removing or treating the offending material Declaration by: (required) Waste ProducerWaste Carrier Signed: (required) Full Name: (required) Position: (required) Date: (required)
