Application for disposal of contaminated soil
Please complete this form in full at least 4 days prior to delivery, supplying appropriate details so that there is no delay in processing this application. A permit number must be issued before contaminated soil will be accepted at the Southern Landfill. Approved applications will be notified by fax or email to confirm acceptance.

Send your completed form to	
Fax to: Southern Landfill Kiosk Fax: 04 383 6631	Email to:  landfillin@wcc.govt.nz	
Hours:  Contaminated soil, once issued with a permit number, will only be accepted:
Monday to Friday, 8am–4pm at the Southern Landfill. Contaminated soil will not be accepted during winter months (from 1 June–31 August).
Fee:	Contaminated soil is charged at $252.43 including GST per tonne.	

Application for disposal of contaminated soil	
Site where the contaminated soil is currently located:	
Brief history of site/description of nature of contamination:	
Please attach results of Total Concentration and/or TCLP tests (as described in MfE guidelines) undertaken at site:	
Business address:	
Contact person:	
Phone/mobile:	Email:	How would you like to be notified to confirm acceptance: (please tick)
Fax	Email	
Fax:			

CB00451-03

Delivery	
Requested date of delivery:	Quantity:	
Odorous:  Yes / No (delete one)
If “Yes” please describe odour:	
Storage site prior to transport:	
Name of transporter:	Name of driver:	

Declaration by generator	
I declare that the above waste application form is accurately described and in proper condition for transport in accordance with the Transport Act.
I hereby accept full liability for any loss or damage, of whatsoever kind including direct or indirect, special or consequential loss arising as a result of any inaccuracy in or omission from the information provided by me and agree to fully indemnify The Wellington City Council for any claims which may be made against The Wellington City Council arising from such inaccuracies or omissions.
Full name: 	

Signature: 		Date: 	 /	 /