SM - WTC (for Testing)

Part 1 - Waste Producer

• Individual Document Number

• Location (choose location via the map locator, or write the closest road and closest town)
  Address

• Select the area of waste collection

  Select Condabri Combabula Spring Gully Orana Peat Duke Gilbert Gully Waar Waar Zig Zag

  • Condabri
  • Combabula
  • Spring Gully
  • Orana
  • Peat
  • Duke
  • Gilbert Gully
  • Waar Waar
  • Zig Zag

• Well name

• Photo of the site the waste was collected from

  Media

• Transport company

  Select BHD ToxFree JJ Richards TC Contractors Transpacific

  • BHD
  • ToxFree
  • JJ Richards
  • TC Contractors
  • Transpacific

• Transporter - Name and Signature

  Sign

• Date and time

  Date

• Local Government area

  Select Maranoa Western Regional Downs Banana Shire

  • Maranoa
  • Western Regional Downs
  • Banana Shire

• Waste Type

  Select Drilling mud - C100 Grease Trap Waste Batteries Acid Paint Cans Oily water Effluent Sewage

  • Drilling mud - C100
  • Grease Trap Waste
  • Batteries
  • Acid
  • Paint Cans
  • Oily water
  • Effluent
  • Sewage

• If waste type not listed, please describe in detail:

• Photo of waste

  Media

Origin Energy Representative - contact details

• Position title

• Contact number of Origin Representative

• Origin Energy Representative - name and signature

  Sign

Waste amount

• Amount of waste - choose one slider below:

• Unit of measure

  cubic metres

  litres

  kilograms

• Amount of waste 0-1000 litres or cubic metres

• Amount of waste 100-50000 litres or cubic metres

Waste Receiving Facility

• Choose the nominated Waste receiving facility

  Select Westrex ToxFree NuGrow Roma NuGrow Swanbank NuGrow Kogan Hahn Reprocessing Wandoan Roma Sewage Treatment Plant

  • Westrex
  • ToxFree
  • NuGrow Roma
  • NuGrow Swanbank
  • NuGrow Kogan
  • Hahn Reprocessing Wandoan
  • Roma Sewage Treatment Plant

Part 2 - Waste Transporter

• Transporting company

  Select BHD ToxFree JJ Richards TC Contractors Transpacific

  • BHD
  • ToxFree
  • JJ Richards
  • TC Contractors
  • Transpacific

• Transporter name and signature

  Sign

• Vehicle Registration Number

• Vehicle Registration Number - 2nd trailer

• Vehicle Registration Number - 3rd trailer

Part 3 - Waste Receiver

• Address of Waste Receiver
  Address

• Name of Waste Receiving Facility

  Select Westrex ToxFree NuGrow Roma NuGrow Swanbank NuGrow Kogan Hahn Reprocessing Wandoan Roma Sewage Treatment Plant

  • Westrex
  • ToxFree
  • NuGrow Roma
  • NuGrow Swanbank
  • NuGrow Kogan
  • Hahn Reprocessing Wandoan
  • Roma Sewage Treatment Plant

• Amount of waste received

• Intended Disposal

  Select Recycling Landfill Chem/Phys Storage Incineration Immobilisation Biodegredation Other

  • Recycling
  • Landfill
  • Chem/Phys
  • Storage
  • Incineration
  • Immobilisation
  • Biodegredation
  • Other

• Waste Receiver name and signature (I acknowledge the receipt of the waste described in Part 1)

  Sign

• Contact number