Waste declaration form for mineral materials Select facility – Välj ett alternativ –Återvinning Grop 21Återvinning ErsmarkÅtervinning Nyhem Information about waste producer, transporter and quantity Waste producer: Company registration number: Contact person: Phone: Email: Transporter: Phone number to transporter: Reference number / object number: The form refers to: This delivery onlyMultiple deliveries Total quantity (tons): Attachments to be submitted (Note! Test results must always be attached): Environmental engineering soil investigationOther analysis or samplingDemolition permit / commencement notice (demolition notification) Test results Sampler (name): Company: Information about the object Municipality: Adress: Property designation: Property owner: Current property use: Process in which the materials originated Process in which the materials originated Renovation/remodelingExploitation/excavationDemolitionSorted out at a waste treatment facilityFrom airport areaNear a fire station or fire drillOther Did you choose other? If so, please specify: Classification waste code Classification waste code Avfallskod Avfallsslag 20 02 01 Trädgårds- och parkavfall bestående biologiskt nedbrytbart avfall från trädgårdar och parker, Materialet avser ris, grenar, krukväxter, växtdelar, mindre mängder jord, ogräs och blommor. 20 02 02 Trädgårds- och parkavfall bestående av jord och sten från trädgårdar och parker 17 05 04 Jord (schaktmassor) och sten Soil / Excavation Typ av massora) Type of masses MoranSilt, claySandBackfill materialTopsoilOther Did you choose other? If so, please specify: Ursprungsplatsb) Place of origin Virgin soil / natural groundBackfilled area / backfill materialRoadwayResidential areaIndustrial areaOther Did you choose other? If so, please specify: c) Do the materials originate from a property where industrial activities or remediation work have taken place, or where there has historically been any type of contamination or emissions? YesNoDo not know d) Are there, or have there previously been, waste dumps, chemical storage sites, tanks, oil separators, or underground pipelines that may have contaminated the soil? YesNoDo not know e) Do the materials contain construction waste or wood (concrete, bricks, stumps, timber, etc.), and/or do they have an unusual odor or color? YesNoDo not know f) Have the materials been generated from excavation of road ditches or railway embankments? YesNoDo not know g) Does the material come from a property where invasive alien species (e.g. Himalayan balsam, giant hogweed or Japanese knotweed) are present? If yes, specify the species under ‘Additional information’ below.. YesNoDo not know Note! Laboratory test results must always be attached confirming that the materials meet the facility’s acceptance criteria (concentration limits). Are additional safety measures required for handling/stockpiling the materials (e.g. flow-prone clay materials)? NoYes If yes, please specify additional safety measures: Additional information Here you can provide any other information that may be useful to Bilfrakt: Signature of waste producer (contractor) Materials delivered that deviate from the information provided in this delivery form and/or do not meet the requirements in the annex with acceptance criteria – so-called ‘non-conforming materials’ – will be rejected by Bilfrakt and transported to an approved receiving facility. Bilfrakt’s costs for sampling, analysis, transport, and disposal at an approved receiving facility for non-conforming materials will be fully charged to the waste producer. Bilfrakt will also charge the waste producer a fee for any additional administrative costs arising from the handling of non-conforming materials. By signing this form, the waste producer undertakes to reimburse Bilfrakt for the costs of handling non-conforming materials as described above. Date Signature Clear Full name and job title
