Laserfiche WebLink
INERT FILL MATERIAL INFORMATION <br /> Name of Inert Fill Material Generation Site.-Project <br /> Material Generation Site Address <br /> Contact Name and Telephone <br /> Material Description (concrete, soil. brick. block, rocks. asphaltic pavement. other) <br /> Type of business or activities at material generation site <br /> Known. suspected or potential contamination <br /> Estimated quantity (tons, yards) <br /> Delivery dates (start to finish) <br /> Shipping method (truck type/size) <br /> GENERATOR CERTIFICATION AND INDEMNIFICATION STATEMENT <br /> The undersigned certifies that the information contained in and attached to this profile is <br /> accurate and complete to the best of his/her knowledge. that till materials to be delivered to this <br /> Aggregate Industries site are clean and inert and that there are no known materials that "ould <br /> significantl% affect the inert nature of the fill materials, nor are there any acid forming materials <br /> or toxic producing materials in said fill materials. Furthermore. by signing this Statement.the <br /> undersigned shall indemnify and hold harmless Aggregate Industries in the event it should be <br /> detennined that an material provided to Aggregate Industries is contaminated %%ith anv regulated <br /> pollutant and/or poses environmental harm. The undersigned shall assume all liability and costs <br /> Aggregate Industries - Inert Fill Materials Profile Form <br /> Page 2 of 31 <br />