Clean Fill Delivery Request Form

Company Name (required)

Contact Name (required)

Address (required)

City (required)

Province / Territory (required)

Postal Code (required)

E-mail (required)

Phone

Fax

Amount of Clean Fill

Number of loads (required)

Size of Load

Source Location of Clean Fill

Type of Clean Fill

Hauler Information

Company Name

Contact Name

Address

City

Province / Territory

Postal Code

Phone

Fax

Request Information

*Material will not be accepted after 2:30 pm.*

Payment Method
CashDebitVisa/MCAccount Number
Date For Delivery Request (required)

Delivery Time (required)

Visa/MC/Account Number

Expiry

Internal Use

OVWRC Authorization

Date

Notification to Landfill
YesNo
Fee Charged
No Charge (Six Inch Minus & Free of all Waste – to be used as Landfill Cover)$20 /mt (Clean Fill but not required for Landfill Cover)Landfill Rate (Zero Tolerance – Fill not clean, contaminated)
Staff Notified

Please phone 24 hours in advance to allow for preparation