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Accueil | Request for disposal of contaminated soil

Request for disposal of contaminated soil

1 - Origin

1.1 Location of contaminated soil (source)
Name:
*
Address:
*
City:
*
Postal code:
*
Telephone:
*
Fax:
Contact person:
Email:
     
1.2 Weight to be disposed of
 
     
1.3 Description of land use or activity
   
1.4 Source of contamination and origin
  *

2- Soil characterisation

2.1 Number of samples taken
 
2.2 Contaminants present
  *
2.3 Name of laboratory that carried out the characterisation
   
** You must attach the laboratory’s MDDEP-accredited certificates of analysis.
File1 (.PDF):
 
File 2 (.PDF):
 
File 3 (.PDF):
 
2.4 Type of soil
Please specify:
 
2.5 Granulometric and hydraulic conductivity analyses
Have these analyses been done?
*
If "YES", attach a copy of the report:
 
2.6 Foreign matter: presence of debris or other matter foreign to the original soil (%) and description
   
Description %  
 
 
 
2.7 Moisture content (if available)
Please specify the moisture content:
 

3- Management

3.1 Agent
 
Name:
*
Address:
*
City:
*
Postal code:
*
Telephone:
*
Fax:
 
Contact person:
 
Email:
*
3.2 Transporter
Name:
*
Address:
*
City:
*
Postal code:
*
Telephone:
*
Fax:
 
Contact person:
 
Billable to:
 
Email:

4- Declaration of Generator or Agent

4.1 Billing address
Name:
 
Address:
 
City:
 
Postal code:
 
Telephone:
 
Fax:
 
Contact person:
 
Email address:
 

5- Comments and additional information

The information above must be provided by the generator of the contaminated soil or their representative.

This form is part of the protocol for accepting contaminated soil in accordance with MDDEP regulations. To dispose of contaminated soil, samples and analyses will be done upon receipt at the Dépôt Rive-Nord Inc. technical landfill, at 1001, chemin Saint-Joseph in Saint-Thomas de Joliette, J0K 3L0.

Soil will only be accepted at the technical landfill in Saint-Thomas upon receipt of this completed form.

HEAD OFFICE

670 Montcalm street
Berthierville (Québec) J0K 1A0
Tél. : 1 800 486-0225
Téléc.: 450 836-1145

R.B.Q 1139-7023-55

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