Fill Management - Payne
Screening Survey
Date
*
-
Month
-
Day
Year
Date
Time
*
Hour Minutes
AM
PM
AM/PM Option
Company Name
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Project Name
*
Project Owner
*
Project Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Current Project Property Use
*
Please Select
Institutional
Parkland/Recreational
Commercial
Residential
Agricultural
Industrial
Type of Soil
*
Please Select
Clay
Sand
Silt
Gravel
Topsoil
Overburden
Mixed
Quantity type
*
Please Select
Tonnes
Cubic Meters
Truckloads
Number of Tonnes
*
Number of Cubic Meters
*
Number of Truck Loads
*
Expected Date of Completion
*
-
Month
-
Day
Year
Date
Is the source a: gas station, garage/repair facility, bulk liquid dispensary, or dry cleaning outfit?
*
Yes
No
Is the source from a known industrial property?
*
Yes
No
Is there known contamination in the soil?
*
Yes
No
Does the soil have any debris in it? Ex. Asphalt, plastic, metal, garbage, lumber, etc.
*
Yes
No
Does the soil have a strong odour? Ex. Gasoline
*
Yes
No
Is the soil very wet? (Excluding Hydrovac slurry)
*
Yes
No
Is the project larger than 350m3, 35 Triaxle Loads or 700 Tonnes?
*
Yes
No
By signing this document you agree that AAROC Aggregates Ltd. reserves the right to reject any soil disposed for reuse. AAROC Aggregates Ltd. will hold the Project Owner/Operator responsible to pay any clean up requirements as deemed by a Qualified Person if soil contamination can be traced to this project.
License Plate #
*
Your Name
*
First Name
Last Name
Signature
*
Submit
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