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Inert Waste Screening Form <br />Date: <br />Time: <br />Location of Waste Source: <br />Hauler Name: <br />Hauler Address: <br />Quantity (Volume) of Waste Received: <br />Description of Waste: <br />TRANSIT MIX AGGREGATES <br />lbs. <br />Criteria <br />Yes <br />No <br />Does the material contain asbestos? <br />Does the material contain hazardous waste? <br />Does the material contain ash? <br />Does the material contain rubble? <br />Does the material contain asphalt? <br />Can the material undergo any significant physical, <br />chemical, or biological transformations? <br />Can the material dissolve? <br />Can the material ignite? <br />Can the material physically or chemically react? <br />F an the material biodegrade? <br />an the material produce a toxic leachate? <br />Signature: Date: <br />